This is the main directory for content on SaveYourself.ca — a wiki-like collection of 232 steadily evolving articles and e-books, plus 249 blog posts (about 535,000 words in all, plus lots more in the nooks and crannies). Browse and sort, or click the gear for more options. Popular articles are highlighted by default. Other starting places: a simpler categorized index, a Reading Guide for Patients and another for Professionals, the big Pain & Injury Survival Tips page, and the Microblog page for news and updates only.
|title click headings to sort||updated ▼||words||size||highlight|
|blogConsider the source+ |
Sting operations have been proving that it’s alarmingly easy to publish bogus science. Ergo, it’s more important than ever to consider the source. Ars Technica:
|new Apr 23, 14Apr ’14||95||•|
|blogThe two-legged dog and biomechanics||new Apr 17, 14Apr ’14||160||•|
|blogThe Salamander’s Law of Bad Therapy+ |
|new Apr 17, 14Apr ’14||10||•|
|blogStretch for torn muscles||new Apr 15, 14Apr ’14||180||•|
|blogNo Heartbleed here+||new Apr 12, 14Apr ’14||35||•|
|blogNew book+ |
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.
|new Apr 10, 14Apr ’14||90||•|
|blogCompression socks with tape||new Apr 10, 14Apr ’14||250||•|
|blogTwo books edited, six to go+ |
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!
|new Apr 9, 14Apr ’14||140||•|
|blogSo…what does work, Mister Smartypants?+ |
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.
|new Apr 9, 14Apr ’14||100||•|
|blogVandal massage||new Apr 3, 14Apr ’14||300||•|
|blogNew anecdote disclaimer||new Apr 2, 14Apr ’14||210||•|
|blogBarefoot resource+ |
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!
|new Apr 2, 14Apr ’14||45||•|
|blogOh, stretching! Can you do anything right?+ |
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).
|new Apr 2, 14Apr ’14||100||•|
|Save Yourself from Shin Splints!+
Do you know why your shins hurt? Shin splints are often not what they seem. With several possible underlying problems, patients often end up barking up the wrong tree. There are four very different types of shin pain. This tutorial breaks it down for you and goes through all the treatment options and recent science. About 20 times more information about shin splints in one place than you can get anywhere else. Ships with a free copy of SaveYourself.ca’s trigger point tutorial!Causes and treatment options for shin splints explained and discussed in great detail, especially shin pain caused by myofascial trigger points, compartment syndrome, medial tibial stress syndrome, and stress fracture
|updated Apr 2, 14Apr ’14||22,000||•••••|
|blogFinancially motivated ignorance||new Apr 1, 14Apr ’14||150||•|
|blogNeck Pain, Submerged!+ |
A “new” article about the worst pain I’ve ever personally survived, cobbled together from old blog posts, updated and tuned a bit:
|new Apr 1, 14Apr ’14||20||•|
|Save Yourself from Plantar Fasciitis!+
Plantar fasciitis is a stubborn pain in the arch of the foot. Yet scientists have proven that certain treatments are effective for most patients — so why don’t more professionals recommend them? Much of the science is new, and old myths die hard. This tutorial debunks the myths and reviews of all the common treatment options. Incredibly detailed, 68 sections in all, and thoroughly referenced.Plantar fasciitis explained and discussed in great detail, including every possible treatment option, and all supported by recent scientific research
|updated Apr 1, 14Apr ’14||37,000||•••••|
|Save Yourself from IT Band Syndrome!+
ITBS is an infamously stubborn lateral knee pain common in runners. Therapy hasn’t been working? You’re not alone. This exhaustively researched tutorial shows that most medical “facts” about the condition are wrong — supported by 142 footnotes analyzing as much of the science as you can stand. Cures cannot be guaranteed, but this tutorial offers both patients and pros 25 detailed treatment options and more insights than you can find anywhere else, as well as a free bonus: SaveYourself.ca’s valuable trigger point tutorial.All your treatment options for Iliotibial Band Syndrome reviewed in great detail, with clear explanations of recent scientific research supporting every key point
|updated Apr 1, 14Apr ’14||51,000||•••••|
|blogCalf size variability+ |
|new Mar 27, 14Mar ’14||60||•|
|blogAudiobooks project cancelled||new Mar 27, 14Mar ’14||170||•|
|blogThe marble hand+ |
Really a delightfully strange illusion.
|new Mar 27, 14Mar ’14||65||•|
|blogThe greatest hits of back pain science||new Mar 26, 14Mar ’14||170||•|
|blogA lot of science is junky||new Mar 26, 14Mar ’14||190||•|
|blogFollow-up on the baby’s broken neck story+ |
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?
|new Mar 25, 14Mar ’14||80||•|
|blogWhat “Big Ortho” doesn’t want you to know!+ |
Can a custom shoe prevent injuries by compensating for individual differences in running mechanics?
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!
|new Mar 25, 14Mar ’14||100||•|
|blogLove letters from librarians+ |
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.
|new Mar 25, 14Mar ’14||30||•|
|blogGoodbye PDF, hello lifetime access||new Mar 20, 14Mar ’14||250||•|
|blogWhen books don’t heal+ |
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:
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!
|new Mar 20, 14Mar ’14||140||•|
|blogHe’s trying to shoot me, all right…+ |
|new Mar 20, 14Mar ’14||35||•|
|blogThe meaning of heel spurs||new Mar 19, 14Mar ’14||210||•|
|blogSay release again||new Mar 19, 14Mar ’14||180||•|
|blogA good friend advances medical science+ |
My friend Dr. Rob Tarzwell is celebrating the publication of this here scientific paper with his name on it. It’s about brain injury, so it’s well off-topic for the salamander … but I’m very interested on a personal level, because my wife’s brain was so badly hurt in an accident in Laos back in 2010. Plus, the tech of it is bloody fascinating (and arcane). My congratulations to Rob on a meaningful and novel contribution to medical science: hats off and high fives!
|new Mar 19, 14Mar ’14||80||•|
|Save Yourself from Trigger Points & Myofascial Pain Syndrome+
Myofascial trigger points — muscle knots — are increasingly recognized by all health professionals as the cause of most of the world’s aches and pains. This detailed tutorial focuses on advanced troubleshooting for patients who have failed to get relief from basic tactics, but it’s also ideal for starting beginners on the right foot, and for pros who need to stay current. 193 sections grounded in the famous texts of Drs. Travell & Simons, as well as more recent science, this constantly updated tutorial is also offered as a free bonus (2-for-1) with the low back, neck, muscle strain, or iliotibial pain tutorials.A guide to the science of muscle pain, with reviews of every possible self-treatment and therapy option, even for the most difficult cases
|updated Mar 19, 14Mar ’14||122,500||•••••|
|Does Massage Therapy Work? A review of the science of massage therapy … such as it is||updated Mar 19, 14Mar ’14||13,000||•••••|
|blogNew massage for fibromyalgia study||new Mar 18, 14Mar ’14||600||••|
Thought I’d get the blogging rebooted with something easy and fun. More substance tomorrow!
|new Mar 18, 14Mar ’14||10||•|
|blogBack to work and blogging||new Mar 18, 14Mar ’14||190||•|
|blogMany (unnannounced) updates and upgrades||new Feb 10, 14Feb ’14||190||•|
|Your Back Is Not “Out” and Your Leg Length is Fine+
“Structuralism” is the excessive focus in the physical therapies on crookedness or “mechanical” problems in the body — what I call the biomechanical bogeymen. It is the source of much bogus diagnosis — things like tilted pelvises, short legs, abnormal spinal curvatures, or “misaligned” anything — and the cause of much therapeutic barking up the wrong tree. Such factors are much less important than many people still believe.
Structuralism has been challenged by many medical researchers and experts like Dr. Lorimer Moseley Moseley, Dr. Scott Dye (knee surgeon); or back experts Drs. Richard Deyo, John Sarno, and Nickolai Bogduk; soft tissue pain experts like the late Dr. Janet Travell, Drs. David Simons and Seigfried Mense (see Muscle Pain), or Dr. Chann Gunn, and on and on.
Many key scientific studies over the years have undermined major structuralist assumptions, like Finan’s finding that knee pain correlates more with pain sensitivity than arthritis; Grundy’s conclusion in Lancet that short leg length differences don’t correlate with back pain; or Grob’s findings that abnormal neck curvatures do not predict neck pain; or Moseley’s finding that a placebo for knee osteoarthritis is just as good as real surgery; or numerous MRI studies showing terrible correlation between structural problems and back pain (see Boden, Jensen, Weishaupt, Stadnik, Borenstein); or the astonishing finding by Haig that even narrowing of the spinal canal does not necessarily cause stenotic back pain; or the clear evidence that even dislocation of the upper cervical spine is often asymptomatic (Swinkels); and so on (and on and on).The story of the obsession with crookedness in physical therapy and treatment for chronic pain
|updated Jan 27, 14Jan ’14||12,000||•••••|
|Trigger Point Doubts+
People routinely experience muscle pain and acutely sensitive spots in muscle tissue — “muscle knots.” They can be surprisingly severe, and massaging them often seems to help quite a bit. What’s going on? The dominant theory is that a trigger point is a patch of tightly contracted muscle, an isolated spasm affecting just a small patch of muscle tissue. Unfortunately, after a few decades it’s still just a theory, and trigger point science is a bit half-baked and somewhat controversial. It’s not even clear that there is really a problem in the meat at all; it could be a sensory “disturbance,” for instance. Meanwhile, people keep hurting, and there is little doubt that there is an important, almost epidemic phenomenon here in need of explaining and treating. Massage — especially self-massage — remains a safe, cheap way of trying to deal with it, and there is some evidence that it can provide some meaningful relief (e.g. Furlan 2008) is probably the best example). That’s why I have a large tutorial devoted to how to self-treat “trigger points” — whatever they really are. But it’s very important to keep in mind that they are not well understood.Is there really such a thing as a muscle “knot”?
|updated Jan 19, 14Jan ’14||9,000||••••|
|Psoas, So What?+The iliopsoas muscle (“illy-oh so-ass”) is a two-in-one hip flexing pair, mostly only palpable through the guts. Its clinical importance is often curiously exaggerated, but sometimes it does need a massage. Massage therapy for the psoas major and iliacus (iliopsoas) muscles is not that big a deal||updated Jan 16, 14Jan ’14||1,300||•••|
|Pseudo-quackery in Chronic Pain Care+Not all quackery is obvious — not even to skeptics. Subtler snake oil is actually a more serious problem in musculoskeletal health care, because it’s harder to spot and much more common, but probably generates just as much false hope and wasted time, energy, money, and even harm. A field with a large gray zone between overt quackery and evidence-based care for chronic pain and injury rehabilitation||updated Jan 16, 14Jan ’14||2,400||•••|
|Dance of the Sarcomeres A mental picture of muscle knot physiology helps to explain four familiar features of muscle pain||updated Jan 16, 14Jan ’14||2,750||•••|
|Does barefoot running prevent injuries? A dive into the science so far of barefoot or minimalist “natural” running||updated Jan 13, 14Jan ’14||4,750||••••|
|Stiffness, tightness, and limited range of motion Is your range actually limited, or do you just feel that way?||updated Jan 9, 14Jan ’14||1,300||•••|
|Save Yourself from Low Back Pain!+
There are thousands of low back pain books — what’s special about this one? The problem is that 90% of doctors and therapists assume that back pain is structural, in spite of mountains of scientific evidence showing … exactly the opposite. Only a few medical experts understand this, and fewer still are writing for patients and therapists. Supported by 315 footnotes, this tutorial is the most credible and clarifying low back pain information you can find. Ships with a free copy of SaveYourself.ca’s trigger point tutorial!Low back pain myths debunked and all your treatment options reviewed
|updated Jan 8, 14Jan ’14||91,000||•••••|
|blogA brief public appearance||new Jan 6, 14Jan ’14||250||•|
|Morning Back Pain An uncomfortable daily mystery for many people||updated Jan 6, 14Jan ’14||2,200||•••|
|Placebo effect? Yawn! Placebo is fascinating, but its “power” isn’t all it’s cracked up to be||new Jan 2, 14Jan ’14||2,400||•••|
|Back Pain and Other Hazards of Sitting In Chairs (Way) Too Much Recent personal experience proves that a lot of sitting actually is as risky as I’ve been telling people all these years||updated Jan 2, 14Jan ’14||3,000||••••|
|Does Ultrasound Work?+
Ultrasound therapy is the use of sound waves to treat musculoskeletal problems, especially inflammation (tendinitis, bursitis). It has been a popular therapy for decades, its use so widespread that it almost defines physical therapy. Unfortunately, although mainstream, it is not as scientific a treatment as most people assume. It has been generally undermined or damned with faint praise by one scientific review after another for more than a decade now. Between 1995 and 2008, what little science has been done on the subject was reviewed in ten papers I considered to be worthwhile (see Gam, Windt, Brosseau, Robertson, Welch, Baker, Buchbinder, Ho, Ho, Jamtvedt). Eight of those were unambiguously negative, some of them strongly so. Authors had almost nothing good to say about ultrasound. Conclusions like this one (from Windt et al) are the rule: “As yet, there seems to be little evidence to support the use of ultrasound therapy in the treatment of musculoskeletal disorders.” Some modern variants of ultrasound are expensive, hyped, and totally unproven for any or many conditions.Many concerns about the widespread usage of therapeutic ultrasound, especially extracorporeal shockwave therapy (ESWT)
|updated Jan 1, 14Jan ’14||3,000||••••|
|Healer Syndrome+“Healer syndrome” is a common delusion of grandeur in alternative medicine, especially massage therapy, naturopathy and chiropractic, where many afflicted professional like to be known as “healers” with allegedly unusual curative powers, vaguely defined and pseudoscientific, and often based on the exaggerated importance of a single idea. Such lack of humility is tragically common. Healer syndrome has reached its most extreme in some of the founders of methods of therapy, “modality empires.” Therapists who think they are God’s gift to therapy||updated Jan 1, 14Jan ’14||1,200||•••|
|Does Chiropractic Work? An introduction to chiropractic controversies||updated Jan 1, 14Jan ’14||5,000||••••|
|Why Does Pain Hurt So Much? How an evolutionary wrong turn led to a biological glitch that condemned the animal kingdom — you included — to much louder, longer pain||updated Dec 28, 13Dec ’13||5,000||••••|
|The Tyranny of Yoga and Meditation! Do you really need to try them? How much do they matter for recovery from conditions like low back pain?||updated Dec 27, 13Dec ’13||1,900||•••|
|Save Yourself from Muscle Strain!+
Got a muscle strain? Maybe … and maybe not. Probably 75% of so-called muscle strains are actually something else. Doctors routinely diagnose muscle strain incorrectly. The muscle strain tutorial is guaranteed to sort it out … and it is just about only the source of information that does. For the majority of readers who’ve been misdiagnosed, the muscle strain tutorial ships with a free bonus tutorial about the problem they most likely do have — myofascial trigger points.Muscle strain (pulled muscle) and muscle pain explained and discussed in great detail, plus every imaginable treatment option
|updated Dec 24, 13Dec ’13||17,000||•••••|
|The Sixth Sense Proprioception, the vital but mysterious sensation of position and movement||updated Dec 24, 13Dec ’13||700||••|
|Save Yourself from Patellofemoral Pain Syndrome!+
PFPS is a common kneecap pain problem — and yet almost universally misunderstood. Patients are often given exactly the wrong advice. There is no miracle cure for patellar pain, but this tutorial is much more detailed than anything else you can find, weighing in at 40,000 words. Both patients and pros can greatly improve their understanding of the options — and maybe that is a kind of miracle. Inspired by the work of surgeon Scott Dye and firmly grounded in readable analysis of the science.Patellofemoral pain syndrome (aka runner’s knee) explained and discussed in great detail, including every imaginable self-treatment option and all the available scientific evidence
|updated Dec 23, 13Dec ’13||56,000||•••••|
|Save Yourself from Neck Pain!+
Who hasn’t had a crick in the neck? This tutorial isn’t the last word on this surprisingly complex subject, but it is a detailed, sensible and scientific survey of what makes a neck crick tick — and your treatment options. Ideal for any frustrated patient with a jammed cervical spine, it’s also helpful for many a therapist not really sure how to treat this quirky phenomenon. Ships with a free bonus, SaveYourself.ca’s valuable trigger point tutorial!All your treatment and self-help options for a crick in the neck explained and reviewed
|updated Dec 20, 13Dec ’13||53,000||•••••|
|The Art of Rest The finer points of resting for injury & pain rehabilitation (hint: it’s a bit trickier than you might think)||updated Dec 14, 13Dec ’13||4,250||••••|
|Do “Nutraceuticals” Help Arthritis and other Aches and Pains? Debunkery and analysis of supplements and food-like medicines (nutraceuticals), especially glucosamine, chondroitin, and creatine, mostly as they relate to pain||updated Dec 12, 13Dec ’13||5,500||••••|
|Does Fascia Matter?+
Fascia therapy and science are considered an exciting frontier in massage and manual therapy, with well-attended fascia conferences featuring “rock star” gurus in the massage world. The main idea is that fascia — tough connective tissue wrapping around all muscles and organs — can get tight and restrictive, and needs to be “released” by pulling on it artfully. Unfortunately, although fascia science may be inherently interesting as biology, no property of fascia has yet been shown to be clinically relevant. No fascial pathology seems to be a factor in any common painful problem, and no method of fascial manipulation is known to “fix” fascia or even change it.
I have challenged readers to cite clinically relevant fascia science. This article reviews three good examples: studies about fascia’s toughness, its contractility, and its fibroblasts. None confirm any clinical relevance of fascia, and one actually undermines it, showing that fascia is too tough to “release.” I also discuss the irrelevance of piezoelectricity, and contradict Gil Hedley’s popular fascial “fuzz” theory of stiffness. The article criticizes fascia excitement from a scientific perspective.A detailed critical analysis of the clinical relevance of fascia science and fascia properties
|updated Dec 11, 13Dec ’13||12,000||•••••|
|Tissue Provocation Therapies+
"There are two “laws” of tissue adaptation, one each for hard and soft tissue. Wolff’s law is that bone will change and strengthen in response to loading. This was first noticed by Julius Wolff in the 19th Century, who got the naming rights. It was greatly refined in the mid 20th century by Dr. Harold Frost, an American surgeon who studied bone biology, and published scientific papers more often than I change my socks. The full details of how bone responds to stress are described in his Mechanostat model. The corollary in soft tissue is the obscure and much less developed Davis’ law. (No one even seems to know who Davis was.)
Although there’s no question soft tissue does adapt to stress, the responses of muscles, tendons, and ligaments are much more complex and less well understood. Many treatments are based on the idea of forcing adaptation or “toughening up” tissues by stressing the tissues. It has always been a reasonable idea, but the devil is in the details: what constitutes the “right” amount and kind of stress is difficult to know, and the results of such therapies have generally been highly inconsistent.The laws of tissue adaptation and provocation therapies like Prolotherapy and Graston Technique
|updated Dec 11, 13Dec ’13||2,300||•••|
|Is Diagnosis for Pain Problems Reliable? Reliability science shows that health professionals can’t agree on many popular theories about why you’re in pain||updated Dec 11, 13Dec ’13||1,400||•••|
|Delayed Onset Muscle Soreness (DOMS) The mysteries of muscle fever, nature’s little tax on exercise||updated Dec 11, 13Dec ’13||6,500||••••|
|Save Yourself from Insomnia! Serious tips from a veteran of the insomnia wars||updated Dec 11, 13Dec ’13||6,000||••••|
|The View from Somewhere+
Readers often prevail upon me to be “objective,” but it’s an over-rated virtue. I am often criticized for a lack of it — always by somone who disagrees with me. And sometimes I am praised for my neutrality — always by someone who agrees with me. But I am not impartial on any of the controversial questions in my field, I’ve never met anyone who is, and I don’t aspire to it.
Objectivity and balance are highly over-rated as journalistic virtues. They are mostly a pretentious delusion, and you should actually beware of those who claim to have them. See Jay Rosen on “the view from nowhere.” And Dan Rather said it well: “I don’t like the word ‘balance’ as applied to journalistic work, because to me, that carries with it at least a connotation that, if you run 15 words about the Republican Party, then you’ve got to run 15 words about the Democratic Party. That’s balance. But I think “fairness” is the word I prefer” (interviewed by Hedrick Smith on PBS, 1996).
Instead of expecting balance, look for someone with a View from Somewhere — from someone who isn’t afraid to disclose and own a bias. That is my goal. Not only will I fail to achieve the ideal of “objectivity,” I assume that my biases are inevitable, constantly egregious, and utterly human. We are all bias machines. We can only keep a bemused eye on this frailty, do some damage control, and try to avoid being emphatic or overconfident about much of anything other than the rise of the sun, death, taxes, and the absurd fallibility of confidence itself. The ideal is not be unbiased, but to be biased with integrity.
|new Dec 7, 13Dec ’13||275||•|
|Quite a Stretch+Stretching just doesn’t have the effects that most people hope it does. Plentiful recent stretching research has shown that it doesn’t warm you up, prevent soreness or injury, enhance peformance, or physically change muscles. Although it can boost flexibility, the value of this is unclear, and no other measurable and significant benefit to stretching has ever been proven. Regardless of efficacy, stretching is inefficient, “proper” technique is controversial at best, and many key muscles are actually biomechanically impossible to stretch — like most of the quadriceps group (which runners never believe without diagrams). If there’s any hope for stretching, it might be a therapeutic effect on muscle “knots” (myofascial trigger points), but even that theory is full of problems. Stretching research clearly shows that a stretching habit isn’t good for much of anything that people think it is||updated Dec 7, 13Dec ’13||12,000||•••••|
|Neck Pain, Submerged! The story of my curious experiment with dunking severe chronic neck pain||updated Dec 3, 13Dec ’13||3,750||••••|
|blogUh oh, success!||new Nov 21, 13Nov ’13||210||•|
Most therapeutic taping is either practical (stabilizing a sprained ankle), or aims to tinker with more subtle biomechanics. Taping has gotten a lot hotter in the last few years with prominent new products and branding, and lots of hype and claims about therapeutic effects, prevention, and performance enhancement. New materials that may achieve different and possibly superior benefits, but probably not much. It doesn’t work biomechanically, as many professionals assume. It’s more likely that the odd sensations change function and reduce pain, but that kind of effect tends to be minimal, and hard to predict and control.Over-hyped, but harmless and at least a little bit promising
|updated Nov 21, 13Nov ’13||1,900||•••|
|blogA tale of two taping papers||new Nov 20, 13Nov ’13||300||•|
|blogMemoirs of a female flight surgeon||new Nov 19, 13Nov ’13||230||•|
|blogA tug-of-war over scraps||new Nov 19, 13Nov ’13||170||•|
|blogDo our bones influence our minds?+ |
Do our bones influence our minds? “Who thinks of the bone as being an endocrine organ? You think of the adrenal gland, you think of the pituitary, you don’t think of bone.” But apparently you should.
|new Nov 19, 13Nov ’13||35||•|
|blogKnee arthroscopy does not work+ |
The data is now overwhelmingly negative. DoctorDoubter:
And that’s why I link to him.
|new Nov 13, 13Nov ’13||35||•|
|blogNot so new+ |
Mea culpa: that knee ligament “discovery” I linked to yesterday? Not so much discovered as “looked at more careful like.” Studied, classified. Perfectly worthwhile research, but over-hyped by the media reporting about it. It was definitely hyperbole to describe it as a discovery. It’s been known of for at least a century, and a paper last year reported finding it in every knee they looked at. I didn’t look more carefully at the story because it was just a minor interesting thing (and anatomy really is never done), but it’s amazing what even a tiny little bit of hype will do. Hat tip to Tony Ingram of BBoy Science for raising my awareness.
|new Nov 7, 13Nov ’13||110||•|
|blogNew ligament+ |
And perhaps iliotibial band syndrome? I don’t see any obvious relevance to ITBS — this new ligament is a little low for that — but I’ll be mulling it over. Regardless, it’s a fun discovery. Contrary to what people assume, “basic” anatomy is still a work in progress.
|new Nov 6, 13Nov ’13||80||•|
|blogHow many sets is enough?||new Nov 5, 13Nov ’13||170||•|
|Less Is More Than Enough Go to the gym less frequently but still gain strength fast enough for anyone but a bodybuilder||updated Nov 5, 13Nov ’13||7,000||••••|
|blogMicroblog changes+ |
The SaveYourself.ca “microblog” was introduced in March of 2013, a minimalistic format optimized for bite-sized posts and announcements. This week it got its first big upgrade: small as they are, posts now have their own dedicated pages (instead of just living in a big list). For instance, see the last post, “Dissing dyskinesis.” Or — random example — the very popular “Good news about running.”
There could be a little strangeness with the RSS feed at first, probably duplicates of recents posts, but it will be fine going forward.
|new Nov 1, 13Nov ’13||85||•|
|The Great Ice vs. Heat Confusion Debacle A quick guide that explains when to ice, when to heat, when not to, and why||Oct 24, 13Oct ’13||650||••|
|blogDissing dyskinesis||Oct 22, 13Oct ’13||240||•|
|blogYou too can learn to feel a hair!+ |
Alert reader Michael B. sent me this example of crazy clinical arrogance about diagnosing by feel (palpation), How To Get Out Of Pain In 30 Days. There’s a million crappy miracle cure sales pitches out there, of course, but this one stands out for its emphasis on near-magical powers of palpation in particular, an entertainingly distinctive delusion of grandeur.
Yes, that’s all it takes to get “x-ray hands”: hair rubbing. And if you believe that, I’m having a bridge sale. I’ve written about this particular flavour of nonsense before…
|Oct 21, 13Oct ’13||130||•|
|blogIt’s not medical+ |
There is no such thing as “medical acupuncture.” The term is oxymoronic propaganda, a common way to make acupuncture seem more legitimate. But it’s all just acupuncture: defeated in one rigorous clinical trial after another for many years now.
|Oct 21, 13Oct ’13||35||•|
|blogLike getting blood from a bone||Oct 21, 13Oct ’13||375||••|
|Palpatory Pareidolia Sensory illusions, wishful thinking, and palpation pretension in massage and other touchy health care||Oct 18, 13Oct ’13||2,500||•••|
|Fatigue-induced muscle rippling+
Muscle fibres do not normally contract all at once, as most people imagine. Instead they are organized into groups called “motor units,” one per motor nerve. Rather than firing all at once, the groups alternate their contractions, like pistons. At any given time, countless motor units are in different phases of contraction and relaxation. The units are so small and the switching system is so fast that their coordinated action seems to be completely smooth to us.
There is an interesting exception, though: if you get tired enough that a lot of motor units start failing to contract, the switching system fails because there aren’t enough motor units available for smooth contraction. This is why muscles start to ripple and quiver with very intense exertions.
This phenomenon has no official name that I know of. It is sometimes called “fasciculation,” and I used to do that myself, but it’s an error: that’s just the smartypants word for an involuntary contraction, a twitch or spasm. This rippling business happens in a resting muscle as well a contracting one.
|Oct 17, 13Oct ’13||180||•|
|blogReflexology “science”||Oct 4, 13Oct ’13||190||•|
|blogTherapy dominated by obsolete ideas+ |
In a 2011 paper, “The Modernisation of Manipulative Therapy,” Australian physiotherapist Max Zusman writes:
|Oct 3, 13Oct ’13||5||•|
|blogHow to run really, really far+ |
Extreme examples are educational. For instance, we know from the experience of ultra runners that it is possible to run in a way that is less hard on your body. Once again, consider the case of Philippe Fuchs, who ran from Paris to Beijing, covering ~5,100 miles in 161 days. His primary concern was his “ability to keep absorbing muscular and skeletal punishment day after week after month,” of course. By the time Fuchs finished, he had developed an endurance stride that was clearly shorter and lower: he padded along with about 6% more steps per mile, a whopping 30% less time in the air, and 11% less landing force. I’m betting he wouldn’t have made it without those adjustments. Fascinating!
|Oct 2, 13Oct ’13||120||•|
|The Functional Movement Screen (FMS)+The Functional Movement Screen (FMS) is a set of seven physical tests of coordination and strength, especially “core” strength, invented in 1997 and now in widespread use around the world. It was originally proposed as a trouble-detection system, which is baked into the name: it’s a “screen.” Its use in the wild seems to over-reach this stated purpose. The popular screening system for athletes failed to detect recent injuries in a new study||Oct 2, 13Oct ’13||3,000||••••|
|Pain Science What recent pain science can do for your chronic pain right now||Oct 2, 13Oct ’13||7,000||••••|
|blogSaveYourself faster!+ |
20 hours per day faster. Sorta. The slowest part of downloading most web pages is the images. Although SaveYourself.ca pages are already fast (under one second for most visitors), a good chunk of that time is images.
From the Dept. of Long Overdue Chores: hundreds of images on SaveYourself.ca have now been replaced with lighter, aggressively web-optimized versions that download about 20% faster on average. It doesn’t sound like a lot, but with about 18,000 page visitors per day, it definitely adds up. In fact, it will save (very roughly, lots of variables) about twenty hours of data downloading time for my visitors every single day. With more and more people on cellular data plans, that actually matters!
|Oct 1, 13Oct ’13||110||•|
|No Comment Why I have never allowed public comments on SaveYourself.ca like most blogs, and never will||Sep 27, 13Sep ’13||1,100||•••|
|blogTight hamstrings, back pain, and movement||Sep 24, 13Sep ’13||190||•|
|blogPain’s complexity+ |
“It’s all coming from the ____, I know it!” The temptation to boil the cause of chronic pain down to a single culprit can be almost overwhelming, but you must resist. Single causes of long term pain are almost unheard of. Nearly all chronic pain is a witch’s brew of different factors, complex by nature (not just coincidence or bad luck). This makes it harder to beat overall, but some factors are more treatable or manageable than others. Find and work with those.
|Sep 24, 13Sep ’13||80||•|
|blogBad biomarkers, good knee news||Sep 20, 13Sep ’13||275||•|
|blogWhat’s a runner gotta do?+ |
Here’s a short, fascinating ultra-running case study with a counter-intuitive outcome: Philippe Fuchs ran from Paris to Beijing, covering ~5,100 miles in 161 days. He “lost five pounds during the run, and his percent body fat dropped from 21.5% to 16.5%. You’d think this would make him more oxygen efficient. It didn’t.” Damn! Biology is wacky.
|Sep 20, 13Sep ’13||55||•|
|blogTouch-testing the world+ |
new article about Kinesio Tape® and similar products, which explains that therapeutic taping is mainly just a sensation tweaker, and that’s fine as far as it goes. We humans are neurological input-output machines. We constantly, systematically, creatively tinker with how we feel … touch-testing the world. This is why I have no strong objection to therapeutic taping, but also why I will probably never be impressed by it: it’s just another method of playing with how our bodies feel, one of many. But it will never trump functional challenges as the main drivers of recovery and performance. The bottom line is always going to be that we have to push ourselves a little to get better than we are — and being taped just isn’t much of a challenge.
|Sep 19, 13Sep ’13||130||•|
|blogPerformance enhancement+ |
“Performance enhancement” is usually a problematic claim, because it’s commonly based on sloppy extrapolation from recovery effects (which are themselves often a bit sketchy). Even what genuinely helps people who are sick or broke is not necessarily going to do anything for fit, healthy people. Or vice versa. (Simple example: compression bandaging for swelling. Unambiguously handy in recovery … but useless if you’re not swollen!) Rehabilitation and performance enhancement are just different things. On the one hand, they are the same process with different starting points. On the other hand, how much value the body can extract from an input is generally proportionate to need. A glass of water is more important to a man dying of thirst, and novel sensation is more neurologically useful to an injured person than a healthy Olympian.
|Sep 19, 13Sep ’13||130||•|
|blogThe prodigy problem||Sep 17, 13Sep ’13||170||•|
|blogHow to dismiss science you don’t like+ |
There’s always a way! This is both deep and funny — nice work by Dylan Matthews at Wonkblog. It seems like a bit of a credibility disaster for science analysis, but don’t be too cynical: most scientific papers legitimately do not deserve an A-grade. Like any good science writer, I try hard to dismiss only the evidence that actually deserves it.
|Sep 16, 13Sep ’13||60||•|
|blogNot good enough, Pilates+ |
It is a widely and passionately held belief that back and abdominal strengthening will help back pain, and Pilates is the branded exercise system dedicated to core strengthening, so Pilates must be good for back pain, right? But in a recent test by Miyamoto et al, patients who did Pilates had “small benefits” compared to those who did not. And the test had a serious flaw: it neglected to compare Pilates to other any other kind of activity (shamefully sloppy design, fairly junky science). These results only add to the pile of evidence that exercise and therapeutic attention of any kind are probably good for low back pain. It’s only worth reporting these results insofar as they damn Pilates with the faintest possible praise — evidence that Pilates has no special power over back pain. I am not even a tiny bit surprised by this.
|Sep 12, 13Sep ’13||140||•|
|blogEducated guesses+ |
Ideas based only on educated guessing about biology, however reasonable and plausible they may sound, have a nasty habit of falling apart when more directly tested. This is one of the strongest patterns in the history of medicine. A classic modern example is autologous blood injections for tendonitis: an idea that sounds promising if you just talk about the biology, but fails when tested on actual patients.
|Sep 11, 13Sep ’13||60||•|
|blogWhat people really look like+ |
Because, of course, what we see in magazines and movies aren’t really people anymore, but skilfully lit and pixel-manipulated artwork — beautiful in their own way, of course, or why bother? But they are only distant, abstract cousins to homo sapiens. In all my years massaging, I never experienced a client as “ugly.” It just isn’t possible when you’re actually paying attention to the person.
|Sep 10, 13Sep ’13||120||•|
|blogPain vs. brain: a follow-up||Sep 5, 13Sep ’13||300||•|
|blogWeights as good as a run?+ |
What if it was just as good for your aerobic fitness to lift weights as to run? Here’s a paper that says it probably is. The authors have a bias favouring this theory, and there’s no real evidence about it yet, but it’s plausible and they make several perfectly reasonable points about the basic exercise biology. At the very least, it does firmly support the idea that building strength is better for general fitness than most people realize (which is all I’m really after). More detail in the bibliography:
|Sep 5, 13Sep ’13||90||•|
|blogPain vs. 1600 pounds||Sep 4, 13Sep ’13||180||•|
|blog“Just” a half hour+ |
A “half hour run” sounds so innocent. I’ll just go for a half-hour run. See? No big deal, right? But I can really kick my own ass in thirty minutes.
|Sep 3, 13Sep ’13||30||•|
|blogNeedless needles?||Aug 29, 13Aug ’13||160||•|
|blogBecause fascia||Aug 29, 13Aug ’13||210||•|
|blogBiomechanicomplicated||Aug 29, 13Aug ’13||200||•|
|blogMobilizing cat+ |
Perfect little animation to whimsically “demonstrate” mobilizations (dynamic joint mobility drills). Gifs are big files, so this is a tiny version, but zoom for the full size (1.7MB!).
Also, not that it really matters, but this cat looks exactly like my cat (no longer with us, RIP) and that couch looks exactly like my couch. See?
|Aug 27, 13Aug ’13||55||•|
|blogDoes [favourite massage method] work?||Aug 27, 13Aug ’13||230||•|
|The Pricing of SaveYourself.ca e-Books A candid discussion about my prices and how I present them to new visitors||Aug 26, 13Aug ’13||950||••|
|Why Massage Therapy? An attempt to explain the magic of touch therapy, and why I decided to become an Registered Massage Therapist||Aug 26, 13Aug ’13||3,250||••••|
|blogEnhanced placebos||Aug 22, 13Aug ’13||170||•|
|blogNever give up+ |
Never give up, because you can recover from damn near anything … if you are patient and methodical. Gene Lawrence, a 74-year-old record-setting powerlifter, tore his quadriceps. Eight months later he’s on the verge of beating his personal bests: total recovery. Bret “The Glute Guy” Contreras tells his story, and some other tales of extreme recovery, and extracts some lessons.
|Aug 22, 13Aug ’13||60||•|
|blogIs science your enemy?+ |
Hint: no (certainly not when properly defined). Todd Hargrove has “noticed that some of my colleagues in the bodywork community are somewhat disapproving of using a scientific approach to understanding how the body responds to manual therapy.” Indeed! But he’s also noticed a positive trend, and I agree: it is getting better, and it has a lot to do with blogging and social media. Nice post, with a nice mention for yours truly and several more I know well. Thanks, Todd.
|Aug 22, 13Aug ’13||80||•|
|blogWonky knees||Aug 20, 13Aug ’13||200||•|
|blogHappy traffic stats, ScienceBasedMedicine.org news||Aug 20, 13Aug ’13||375||••|
|Therapy Babble Hyperbolic, messy, pseudoscientific theories about therapy are all too common||Aug 20, 13Aug ’13||3,250||••••|
|Ten Trillion Cells Walked Into a Bar A humourous and unusual perspective on how, exactly, a person is even able to stand up, let alone walk into a bar||Aug 20, 13Aug ’13||2,300||•••|
|blogHooray for thorough massage!||Aug 15, 13Aug ’13||250||•|
|blogWhy are non-USD prices for my e-books so much higher than the going exchange rate?||Aug 15, 13Aug ’13||220||•|
|blogWhen to worry about back pain||Aug 14, 13Aug ’13||220||•|
|The Bark and the Bite of Low Back Pain When you should worry about low back pain, and when you shouldn’t||Aug 13, 13Aug ’13||2,400||•••|
|blogGood screening news||Jul 31, 13Jul ’13||150||•|
|blogShould I run recklessly?+ |
Real question from a runner:
Um, no … in (at least) 2 important ways:
First, of course, there’s just a real risk of making any injury much worse that way. Duh! There are exceptions, but you need to know what those are — you need a clear and specific rationale for breaking a generally excellent rule.
And second, “stuffing” with pain-killers is seriously risky and useless to boot. Pain-killers are bandaids at best, possibly not even that, and definitely not a good long term solution, because there isn't a single one that doesn't have truly serious hazards with chronic use (not the least of which is their effectiveness wanes).
|Jul 30, 13Jul ’13||120||•|
|blogCritical what?+ |
Critical what? Hardly a day goes by I don’t read something smart online about critical thinking: how important it is, how to do it. It’s everywhere. So … why is still so much not-so-critical thinking floating around out there?! It seems odd.
The answers are obvious of course: above all, good quality thinking is a skill, because it requires working around obstacles that are truly unknown to us without training (obscure logical fallacies and sneaky cognitive distortions). It’s a hard skill to learn even for people who are super motivated. There’s almost no chance if it threatens comforting beliefs… or, worse, the basis for making a living!
But it still seems mighty peculiar and ironic that there’s so much good information available about critical thinking that isn’t being used.
|Jul 30, 13Jul ’13||120||•|
|blogYoga for neck pain+ |
A small experiment (Cramer et al) optimistically concluded that Iyengar yoga helped neck pain more than a generic exercise program. But this research was too flawed to trust. Dr. Edzard Ernst was not impressed, and I entirely agree with him: “One does not need to be an expert in critical thinking to realise that… the positive outcome might be unrelated to yoga.”
|Jul 25, 13Jul ’13||60||•|
|blogThe placebo paradox+ |
How refreshing! A perspective on placebo that doesn’t worship the “power” of placebo, but looks instead at the paradox of placebo: if placebo is so ding dang powerful, why isn’t everyone cured? Perhaps because the placebo effect is basically a dysfunctional mistake. Here’s a video, Why does the placebo effect work? 6:01, and here’s the scientific paper it’s based on, Humphrey & Skoyles, Current Biology, 2012 — and here’s some excellent some extra reading from Seattle Rolfer Tod Hargrove, who did a nice job interpreting and explaining the scientific paper. The additional perspective is most welcome.
|Jul 25, 13Jul ’13||90||•|
|blogMore pain = more pain||Jul 23, 13Jul ’13||170||•|
|blogSelf-improvement through pain+ |
Rob Heaton, How chronic pain has made me happier:
This sentiment was perfect for my article about healing by growing up.
|Jul 23, 13Jul ’13||140||•|
|blogIntelligent rabbit massage||Jul 22, 13Jul ’13||150||•|
|Healing by Growing Up Pain relief through the pursuit of emotional intelligence, life balance, and peacefulness||Jul 20, 13Jul ’13||2,000||•••|
|blogWhy so negative?+ |
I deal with a lot of controversial subject matter. I debunk and criticize many products, services and ideas, which many perceive as “negative” … while I perceived it as “ethical” and generally have a lot of fun taking my subject matter seriously.
I’ve been writing about my so-called negativity off and on for years. I’ve prepared a compilation of tales of outrageous hate mail, quotes and comics and quite a bit of whimsy and eye-rolling, the ethics and tactics of debunking, what’s it like to be an “enemy of massage,” and — my favourite — “advanced negativity,” a discussion of how cynicism is baked into science in the form of the null hypothesis.
|Jul 19, 13Jul ’13||110||•|
|blogNoise, noise, noise!+ |
Noise, noise, noise! I am often asked about the meaning of knee noise (“crepitus”), which can often be quite spectacular — surely the loudest joint in the body. But knee noise in the absence of any other clear signs (like pain) is usually uninterpretable. It does not correlate well with problems. So you can be in trouble ... silently. And you can be fine... noisily. Rule of thumb: crepitus is only of concern if you’re also in pain, and not necessarily even then.
|Jul 18, 13Jul ’13||80||•|
|blogRisk vs benefit||Jul 17, 13Jul ’13||50||•|
|blog“Disc” pain+ |
In this 2003 study of 31 Olympic athletes with back pain/sciatica, only about half had signs of disc degeneration or bulging. These are elite athletes, not malingerers. If they say they hurt, they hurt! Yet MRI failed to identify a disc problem in half of them. Just one of many studies of this sort cited in my low back pain tutorial.
|Jul 16, 13Jul ’13||60||•|
|blogAllTrials is going well+ |
AllTrials.net is trying make sure all pharmaceutical research results are reported — not just results that make drugs look good. The project is going better than I dared to hope. From an encouraging update on the project website: “Major organisations around the world are now taking this problem more seriously than ever before… The problem of trial results being withheld has been well documented for three decades, with poorly implemented fixes along the way, but now there is clear policy movement.” Excellent!
|Jul 16, 13Jul ’13||80||•|
|blogTerrible and wonderful+ |
Odds that I would share this? 100%! Some things are just unavoidable. When one of my favourite comic artists ever (Matthew Inman of The Oatmeal) creates something detailed (six parts!) about long distance running — The Terrible & Wonderful Reasons Why I Run Long Distances — yeah, I’m definitely gonna share that. Because I’ve written three whole books about the consequences of long distance running.
|Jul 16, 13Jul ’13||65||•|
|Massage Therapy for Bruxism, Jaw Clenching, and TMJ Syndrome Perfect Spot No. 7, the masseter muscle of the jaw||Jul 11, 13Jul ’13||2,300||•••|
|blogGood news about running+ |
|Jul 9, 13Jul ’13||85||•|
|The ‘Use It Or Lose It’ Principle+Staying generally active is now well-known to be a significant factor in longevity and sustained quality of life — it is one of the most clearly known things in all of health science (see Puetz or Buettner, for instance, or Larson or Corcoran or Nakazawa, and many, many more). The importance of stimulation and movement in healing||Jul 9, 13Jul ’13||1,400||•••|
|A Better Hot Bath Tips for getting the most out of the oldest form of therapy||Jul 9, 13Jul ’13||2,500||•••|
|Why So “Negative”?+I criticize many poor ideas in health care, so I often seem “negative,” especially to people who truly believe in treatments I debunk. But defending patients from false hope and fraud is a Good Thing, I also report on many effective treatments, and I have fun taking my subject seriously. Not so negative after all! Answering accusations of negativity, and my reasons for being a health care debunker||Jul 8, 13Jul ’13||4,750||••••|
|blogDramatic acupuncture harm+ |
Egads, worst case scenario here. Eyebrow-raising pictures. Canadian Olympian’s ‘nightmare’ after acupuncture needle collapses her lung.
|Jul 5, 13Jul ’13||15||•|
|blogPainful neck = weak breathing+ |
Intriguing: this test of 90 patients (half with neck pain, half without) showed that neck pain correlates pretty clearly with weak breathing. But is the weakness a cause? An effect? A bit of both, perhaps — if I had to guess (and I do have to guess), I’d guess “all of the above.” Both pain and weakness are probably both a cause of AND an effect of the other.
|Jul 5, 13Jul ’13||65||•|
|blogLess is more than enough||Jul 3, 13Jul ’13||150||•|
|blogI’m officially more important now||Jul 2, 13Jul ’13||375||••|
|blogWhy is back pain still a huge problem?+ |
Why is back pain still a huge problem? Here’s an articulate explanation from a new paper by Max Zusman:
Nicely said. More simply: patients believe back pain is caused by structural fragility, and therapy careers are often built on catering to that belief.
If only I could edit it, though, I would say instead that it is difficult to alter that belief in anyone, patient or professional. The overemphasis on fragility isn’t just reinforced by the practices of manual therapists, it’s the reason for many of them.
|Jul 2, 13Jul ’13||140||•|
|blogDerpish stupidity+ |
“Derp” defined as a Bayesian probability concept: the persistent refusal to update beliefs about what is likely to be true based on new evidence.
The word “derp” originally comes from pop culture, but has come to be used most earnestly in political punditry, referring to the extreme mental ruts characteristic of American right-wing extremists. But derpish stupidity is also rampant in health care, and this more technical definition of what derp has come to mean in politics is a pitch perfect description of how quacks defend their beliefs — namely, with self-serving assumptions that are impervious to contrary data, and are literally decades or even centuries behind biology and medicine.
|Jul 2, 13Jul ’13||100||•|
|The Mind Game In Low Back Pain How back pain is powered by fear and loathing, and greatly aided or cured by rational confidence||Jul 1, 13Jul ’13||1,000||•••|
|Do You Believe in Qi? How to embrace a central concept of Eastern mysticism without being a flake||Jul 1, 13Jul ’13||800||••|
|blogHoly spinal adjustment, Batman!+ |
Overheard: a chiropractor speaking of an upper cervical treatment said to a patient, “Your neck is now in God’s alignment.” Not just an adjustment — it’s holy! Oddly enough, and little known to many patients, there is a strong theme of Christian fundamentalism in chiropractic that blends seamlessly with the work, as though chiropractic is a spiritual calling. It is strange and distasteful to virtually anyone but another fundamentalist Christian.
|Jun 29, 13Jun ’13||70||•|
|blogKnee surgery denounced by surgeons||Jun 26, 13Jun ’13||200||•|
An understatement from Dr. Harriet Hall writing for ScienceBasedMedicine.org: “Since knee osteoarthritis is such a ubiquitous annoyance, home remedies and CAM offerings abound.” Boy, no kidding. That’s from Dr. Hall’s short, clear summary of a major report on treatments for knee arthritis.
|Jun 25, 13Jun ’13||40||•|
|blogCat pets baby+ |
And now for a totally uncontroversial post (?) featuring a short, sweet video of a gentle cat, a tired baby, and the Awesome Power of Touch. Aaaw!Cat soothing crying baby to sleep 1:40
|Jun 25, 13Jun ’13||25||•|
|Spinal Nerve Roots Do Not Hook Up to Organs! One of the key “selling points” for chiropractic care is the anatomically impossible premise that your spinal nerve roots are important to your general health||Jun 21, 13Jun ’13||2,400||•••|
|blogRunning still good for you||Jun 13, 13Jun ’13||170||•|
|blogScience isn’t broken||Jun 8, 13Jun ’13||210||•|
|blogApplied “Kinesiology”+ |
Another new sassy micro article, criticizing another off-the-wall part of alternative medicine: Applied “Kinesiology”, which has nothing to do with kinesiology, and often wastes the time and money of patients with chronic pain. They deserve and need much better. As with my therapeutic touch article earlier this week, this is another topic I have little patience for, but it’s too common to entirely ignore — so here’s my brief position statement. As usual, critics need to know before commenting that I have plenty of direct experience with every scrap of pseudoscience that I now criticize.
|Jun 7, 13Jun ’13||80||•|
|blogResearch tip+ |
Another new micro article, and the seed of a larger one. I’ll definitely add to this one in time: PubMed Research Tip: A simple tip to help clinicians get more useful results from PubMed
|Jun 5, 13Jun ’13||20||•|
|blogFailed healing+ |
Most of the time it’s hard not to heal. You couldn’t stop it if you tried — not that you’d want to. The body is going to recover from most kinds of injuries almost no matter what — it’s just a matter of time. As long as you were reasonably healthy before you were injured (and you don’t smoke or otherwise abuse your vitality), healing will usually progress inexorably.
Chronic pain is different by definition: it doesn’t stop when it’s supposed to. Either healing itself fails, or the pain continues even when the tissues are fine, or a bit of both. Overuse injuries or repetitive strain injuries (RSIs) like carpal tunnel syndrome and plantar fasciitis are slow-motion traumas that often seem immune to recovery — this is what makes them both terrible and fascinating. They are not as simple as they seem. More:
|Jun 4, 13Jun ’13||140||•|
|blogNow hear this: 5 new audio articles+ |
They aren’t free (unless you are a blind or low-vision visitor). I created these to be a nice perk for my best customers, who have bought a bundle of all my e-books, the e-boxed set.
|Jun 4, 13Jun ’13||120||•|
|blogActual touch not included+ |
I’ve never written about therapeutic touch before, or gotten involved in the many online debates about energy medicine that are more or less constantly burning somewhere on the internet (especially Facebook). I am a science writer, my plate is plenty full with that, and I just couldn’t be bothered delving into that very anti-scientific topic. On the other hand, I also want to “touch” on every therapy and pain topic, at least a little — that’s my ultimate writing goal for SaveYourself.ca. So I finally got around to it.
|Jun 4, 13Jun ’13||120||•|
|blogGood questions about orthotics||Jun 4, 13Jun ’13||160||•|
|blogRippling muscles!+ |
|Jun 4, 13Jun ’13||15||•|
Therapeutic touch (TT) is hands-off aura massage, actual touch not included, and it is the most common form of energy or chi medicine. Many years ago I believed in it, but that’s true of Santa Claus too; eventually I decided it was nonsense based only on wishful thinking, laughably naive references to quantum physics, and wide-eyed exaggeration of ordinary social interaction effects. Most practitioners are massage therapists and, oddly, nurses. TT is a culturally neutral subset of Japanese reiki, which has been successfully exported around the world. (Reiki practitioners have the infamously obnoxious holier-than-thou habit of calling themselves “masters.” •eyeroll•)
Auras do not exist and cannot be felt, let alone manipulated therapeutically. Just as dousers and psychics have never passed a controlled test, TT practitioners cannot not detect a person by feeling their aura (see Rosa et al), which makes them look ridiculous.
It is peculiar and pleasant to have someone wave their hands all around you with friendly intentions, but those effects are minor and fleeting and it doesn’t matter what specifically the therapist does, because it’s the interaction that is the active ingredient. (Hence the term “non-specific effects,” a cousin of placebo.) There’s no problem with doing therapy in a way that optimizes non-specific benefits, but it has strict limits. Placebo is nowhere near as “powerful” as people believe (usually for self-serving reasons), and there are all kinds of ethical and practical problems with cluttering up the interaction with interpretations of what’s going on.
|Jun 4, 13Jun ’13||275||•|
|blogResisting postural assessment+ |
Or: How I made a newbie massage therapist cry once. An update to my main posture article:
|Jun 3, 13Jun ’13||15||•|
|blogSome gold standard+ |
Probably the first ever placebo-controlled study of surgery for tennis elbow … and disappointing. The experimenter scathingly concludes:
Kroslak. Surgical treatment of lateral epicondylitis: A prospective, randomised, blinded, placebo controlled pilot study. Unpublished. 2012.
|Jun 3, 13Jun ’13||65||•|
Readers often prevail upon me to be “objective,” but it’s an over-rated virtue. Not only will I fail to achieve the ideal of “objectivity,” I assume that my biases are inevitable, constantly egregious, and utterly human. We are all bias machines. We can only keep a bemused eye on this frailty, do some damage control, and try to avoid being emphatic or overconfident about much of anything other than the rise of the sun, death, taxes, and the absurd fallibility of confidence itself.
|Jun 3, 13Jun ’13||80||•|
|blogCRPS science “something of a mess”+ |
What works for complex regional pain syndrome? Nothing known. Neil O’Connell: “The trial evidence in CRPS is something of a mess.”
|May 31, 13May ’13||20||•|
|blogGood reviews of crappy studies+ |
From a review of studies and other reviews of surgeries for back pain: “Although the quality of the reviews was quite acceptable, the quality of the included studies was poor.” So back surgeries have never really been studied properly … but the reviews are quality! Hmm. I’m pretty sure that’s terrible news.
|May 31, 13May ’13||50||•|
|blogPlacebo PSA+ |
Because people cannot seem to be reminded of this enough: Human beings will get great placebo from any treatment that seems impressive in any way (more invasive, novel, unpleasant, whatever suggests potency). This accounts for most treatment success stories from both patients and professionals. Everyone should know better than to trust those stories — because it’s 2013, not 1913 — but they are still prevalent, given far too much weight, and they hijack most conversations about what works and what doesn’t for stubborn painful problems. As soon as someone says, “Well, it works for me/my patients,” that’s pretty much the end of any useful debate.
|May 31, 13May ’13||100||•|
|blogGood back pain science news||May 30, 13May ’13||160||•|
|PubMed Research Tip A simple tip to help clinicians get more useful results from PubMed||May 29, 13May ’13||170||•|
|Repetitive Strain Injuries Tutorial Five surprising and important facts about repetitive strain injuries like carpal tunnel syndrome, tendinitis, or iliotibial band syndrome||May 29, 13May ’13||11,000||••••|
|Orthotics Guide A consumer’s guide to the science and controversies of orthotics, special shoes, and other (allegedly) corrective foot devices||May 29, 13May ’13||3,500||••••|
|Save Yourself from Tension Headaches! Simple advice on healing from chronic tension headaches, also known as fibrositic headaches||May 29, 13May ’13||1,800||•••|
|Save Yourself from Tennis Elbow! Straight-talking advice on healing from this common tendinitis (lateral epicondylitis) … which doesn't just affect tennis players||May 29, 13May ’13||2,400||•••|
|Does Posture Matter?+Posture matters a little, but not a lot. Most “poor posture” is just bad ergonomics, a different problem. Postures that do harm and have easy fixes are rare; many postures are the result of long-term adaptations and nearly impossible to change. Many people do seem to be vulnerable to postural strain, but they have a problem with vulnerability, not posture. If your main issue is unexplained or stubborn aches and pains, working on posture is not the best way to spend your time: just get more exercise generally, especially tasks that require coordination, and anything you enjoy (inspiration, not discipline). “Advanced” methods taught by posture gurus are generally speculative and over-priced. Posture exercises & strategies for improving posture … and some reasons not to bother||May 29, 13May ’13||13,000||•••••|
|blogA taijiquan spelling bee||May 23, 13May ’13||240||•|
|blogThe wrong notch+ |
A nice example of anatomical variation: the size and shape of a notch in the top of the shoulder blade is quite variable, and nerve impingement is much more likely if you’ve got the wrong type of notch. More anatomical variation examples:
|May 23, 13May ’13||40||•|
|Tai Chi Helps Fibromyalgia, but It’s Not “Alternative” Medicine Despite a high profile boost from the New England Journal of Medicine, it’s still just gentle, elegant, and pleasant exercise||May 23, 13May ’13||850||••|
|The Power of Barking||May 22, 13May ’13||150||•|
Applied kinesiology (AK) is a pseudoscientific method of diagnosis and prescription, used by many chiropractors and naturopaths, and denounced as an absurd parlour trick by everyone else. (AK has no relationship to kinesiology, which is the study of human movement.) Practitioners believe that muscle strength fluctuates meaningfully and is a useful diagnostic tool. They test strength while substances are placed on or near patients, or while asking meaningful questions: strength means the body says yes, weakness means no. This is about as scientific as a ouija board.
There is almost no real AK research: no real scientist would bother with it, or get funding for it. It’s like studying the Nigerian email scam to see if it really works. Even NCCAM hasn’t bothered (NCCAM exists to study alternative medicine).
Patients are often impressed by AK, because it exploits potent illusions based on the ideomotor and observer-expectancy or subject-expectancy (power of suggestion) effects. This is why a magician like James Randi knows exactly how to debunk AK (see also a more detailed video debunking). It fools practitioners just as readily as it fools patients: most are deluded true believers, not scam artists.
|May 22, 13May ’13||275||•|
|blogBlood injection treatment bombs a test+ |
Utterly unsurprising: injecting your own blood doesn’t help tendinitis. Nice to have a decent new trial about this over-hyped therapy though.
Not many good treatment ideas work as well in practice as they do in theory. The null hypothesis is super reliable.
|May 21, 13May ’13||70||•|
|blogThe anti-placebo+ |
Placebo is belief-powered relief from symptoms, while nocebo is belief-powered symptoms, or “the placebo effect’s malevolent Mr. Hyde.” And: “The Internet has become a powerful…nocebo dosing machine.” Agreed: nocebo is a genuine hazard when writing about medical problems. Read more:
|May 21, 13May ’13||40||•|
|blogProgressive mythology+ |
Progressive mythology: Dr. Harriet Hall’s review (plus some excellent reader comments) of Science Left Behind: Feel-Good Fallacies and the Rise of the Anti-Scientific Left, Berezow & Campbell. A great book idea. This quote isn’t particularly representative of the book’s message, but it’s a very important idea (which I have written about):
|May 21, 13May ’13||50||•|
|You Might Just Be Weird The clinical significance of normal — and not so normal — anatomical variation||May 21, 13May ’13||1,900||•••|
|blogNo more store trouble, but sheesh+ |
Thursday and Friday’s trouble with my e-bookstore now seems to be cleared up, but it took a solid 48 hours. Fascinatingly, the slowness of the recovery may have been due to a major hacking incident several weeks ago, which affected basic internet infrastructure: that is, the “Domain Name System” (DNS) may be damaged and/or deliberately slowed down as a security measure. The theory is that corrected information about the location of my e-bookstore took much longer (2 days) to spread around the world than it would have before (2 hours). Here’s an interesting NY Times article about the hacking incident, with good diagrams:
|May 18, 13May ’13||100||•|
|blogService announcement for customers+ |
For most of Thursday and into Friday morning, my online store has been flickering on & off like an old neon sign. Geeks are slaving to restore full service, and seem to have mostly succeded at this point. •mops cold sweat from brow• Part of the problem is that the internet “lost” the correct address for the store. That’s mostly fixed now, but there are still some computers out there that don’t know the correct address. Depending on where you live, you might see a weird generic page instead of my actual store. But the correct information is steadily spreading around the world (“Domain Name System (DNS) info propagation”), and I am fairly confident the worst is over. Naturally I’m readily available for any customer having trouble.
|May 17, 13May ’13||120||•|
|blogPromising new fitness blog+ |
A promising new fitness blog. The State of Evidence-Based Fitness:
|May 17, 13May ’13||10||•|
|blogSurprise run+ |
Ever run much farther than you thought you could? I haven’t done more than 5km in ages, and I often only do 2km at a time (I’ve never been much for distance as a runner, I like sprinting) … and then suddenly a pair of big 13km runs around Stanley Park in a week! The first run was a total shock, and probably an unwise spike in pavement pounding — honestly, I’m amazed I didn’t hurt myself, prone as I am to RSIs. But I got away with it just fine.
And the 2nd run? I had to see if the 1st was a fluke! I guess it wasn’t — I did just fine again. I’ll be danged.
|May 15, 13May ’13||110||•|
|blogReplication needed+ |
“Replication needed” is the ultimate caveat in scientific criticism. It covers all the bases. Everything else is just details. At the end of the day, if promising results cannot be replicated by other researchers, it doesn’t really matter what was wrong with the original research. Either a treatment works well enough to consistently produce impressive results whenever it’s tested … or it doesn’t. Updated article:
|May 15, 13May ’13||65||•|
|The “Impress Me” Test Most controversial therapies are fighting over scraps of scientific evidence||May 15, 13May ’13||450||••|
|blogThe effects of sleep deprivation+ |
Sleep: What the Research Actually Says: A readable review of the effects of sleep deprivation, with good nugget-sized highlights throughout, from my friends at Examine.com, Sol Orwell and Kurtis Frank. One quibble! Nothing about pain. But of course I have something about insomnia and pain (Insomnia Until it Hurts).
|May 14, 13May ’13||45||•|
|blogGood pain reading for pros+ |
Superb paper about pain for professionals, with a very broad scope: it’s just called “Pain.” I love a simple title.
|May 14, 13May ’13||20||•|
|The Runner’s Knee Diagnostic Stand-Off How to tell the difference between the two most common knee pain problems in runners, IT band syndrome and patellofemoral pain||May 14, 13May ’13||1,000||•••|
|blogThe power of barking+ |
This is basically how humans decide what to believe in (e.g. simple correlations, emotional priorities). “I have the power of barking to thank for that.”
|May 10, 13May ’13||25||•|
|blogAntibiotics for back pain reality check+ |
This is great! A nicely written reality check on the antibiotics for back pain hype, from PubMed. Great stuff.
Back pain is one of the richest myth mines in all of medicine. An extremely common, often serious, and usually mysterious pain problem = absolutely maximum fertility for bullshit to grow in. There are a great many books about low back pain, and many are garbage, selling snake oil and hype and false hope instead of good information. There are also some fine myth-busting books about low back pain … and mine is one of them.
|May 10, 13May ’13||90||•|
|blogI was wrong: muscle is cheap, not expensive||May 10, 13May ’13||250||•|
|blogAnd then I read my email…+ |
Sometimes I think: manual therapy is getting progressive, more science-based, clinical reasoning is growing up. Yay!
Then I read my email.
If the contents of my inbox are any measure (and they probably are), then, alas, there is still a great deal of work to do. Crazy numbers of professionals in manual therapy have clearly not even begun to understand the need to properly test treatments. And many even fight it!
|May 10, 13May ’13||65||•|
|blogDo I like “SaveYourself.ca”?+ |
People ask about this occasionally: no, I don’t actually like my domain name, “SaveYourself.ca.” It smacks of religion & too-good-to-be-true promises and I’m not comfortable with that. It’s a legacy from many years ago when I had no idea what this site would become. I plan to move to a new domain name within a year.
P.S. I may not actually like my domain name, but I do still love my salamander mascot.
|May 10, 13May ’13||70||•|
|blogTwo tiny quotes+ |
Just finished reading a slightly trashy novel, Gone Girl, by Gillian Flynn, and mined it for a couple of nice little quotes: “Sleep is like a cat: it only comes to you if your ignore it.” Perfect quote nugget for Save Yourself from Insomnia! And: “To pretend to be calm is to be calm, in a way,” which made me think of posture/mood interdependence, discussed in Does Posture Matter? (Mostly for emotional reasons!)
|May 9, 13May ’13||65||•|
|blogBad icing news?+ |
|May 7, 13May ’13||90||•|
|Icing for Injuries, Tendinitis, and Inflammation Become a cryotherapy master||May 7, 13May ’13||4,000||••••|
|blogStrengthening for the not-so-young+ |
A charming, well-produced video summary of why and how to build strength, pitched to the not-so-young-anymore, done by the University of BC (which is in my backyard).
|May 4, 13May ’13||25||•|
“Modality empire” is my own term for an ego-driven proprietary method or mode of manual therapy — a sub-discipline — championed and promoted by a single charismatic entrepreneur. Most of the “emperors” have healer syndrome, lack humility, make big promises, and make their money from unusually expensive therapy, workshops and books. Professionals are sold on the opportunity to purchase credibility in the form of increasing “levels” of certification, but the quality of these certifications is completely unregulated and often dubious. A modality empire is as much a business model as a method of helping people. There is a lot of overlap between modality empires and quackery. Classic examples of modality empires include Ida Rolf’s ROLFING®, John Barne’s myofascial release, and John Upledger’s craniosacral therapy. Sometimes a modality empire is particularly unoriginal, re-packaging old ideas for a new generation of workshop consumers.A tradition of ego-driven treatment methods in manual therapy
|May 3, 13May ’13||1,400||•••|
|blogIncurable shitty ankle+ |
Comedian Louis CK on aging joints:
|May 2, 13May ’13||60||•|
|blogJedi pain tricks!||May 1, 13May ’13||190||•|
|blogGoodbye supplement confusion+ |
Interesting, impressive new work announced today by Examine.com: a well-crafted new presentation of a huge database of scientific evidence that “clearly tells you what a supplement does (and doesn’t do). Goodbye supplement confusion.” This rabbit hole goes deep, so browse. Look at their “Human Effect Matrix” tables for key topics in particular, which beautifully summarize the science (go right to an example, for creatine). What’s remarkable here is the quality of the presentation. These are not just tables of data! They are quite artful, crafted to emphasize what matters. I would love to have evidence presented like this on SaveYourself.ca, and I do have some of the foundations for it — but I’m a few design and technology leaps away from being able to deliver something like that.
|Apr 23, 13Apr ’13||120||•|
|blogTwo links, one serious, the other … not+ |
This article updated recently: What can a runner with knee pain do at the gym? That’s handy, but this link is more fun: 20 Reasons Why Going To The Gym Is A Huge Waste Of Time (actually just 20 short videos of hilarious exercise misfortune).example
|Apr 22, 13Apr ’13||30||•|
|blogAffectionate or creepy?+ |
The power of touch is strong in these two: a sloth lovingly, thoroughly grooms a cat. So affectionate it’s almost creepy…
|Apr 22, 13Apr ’13||20||•|
|blogBeeeep||Apr 19, 13Apr ’13||160||•|
|blogWe hates the DRMses, my preciousss+ |
Digital rights management (DRM): it’s used by all the big publishers to limit e-book piracy … and we all hates it. You hates it, I hates it. DRM annoys customers, prevents real ownership, makes honest lending nearly impossible, locks e-books to one kind of reader … just yuck. We hates DRM! My e-books are “low DRM.” I do protect my (preciouss) books a little — but a lot less than big publishers do. In particular, it’s easy and fine to lend my e-books!
|Apr 19, 13Apr ’13||80||•|
|blogPain changes how pain works+ |
Pain itself often changes the way the way pain works, so that patients with pain actually becomes more sensitive and gets more pain with less provocation. This awful (and surprisingly common) phenomenon is called central sensitization. Everyone should know about this: owner’s manual stuff.
Another “new” article (assembled from past posts, spiffied up, made into a permanent page)
|Apr 17, 13Apr ’13||55||•|
|blogModality empires||Apr 17, 13Apr ’13||170||•|
|blogX-Ray video+ |
|Apr 15, 13Apr ’13||75||•|
|Digital Motion X-Ray What’s the risk from the radiation exposure?||Apr 14, 13Apr ’13||1,000||•••|
|Toxic Muscle Knots Research suggests that muscle knots (myofascial trigger points) are quagmires of toxic, irritating molecules||Apr 11, 13Apr ’13||950||••|
|blogNot what they seem+ |
After years of practice, I can easily find your infraspinatus muscle. In the dark, in about three seconds. Through a thick towel. However, massage and manual therapists often fool themselves into thinking they are feeling things under their hands that are not actually there, or things that might be there but cannot possibly be detected with any reliability. This is palpatory pareidolia: illusions in the sense of touch.Palpatory Pareidolia: Sensory illusions, wishful thinking, and palpation pretension in massage and other touchy health care
I’ve written about this before, but this is a topic “reboot,” with content combined from a few early drafts and whipped into shape for a permanent article:
|Apr 10, 13Apr ’13||95||•|
|blogHomo sapiens: not as wimpy you thought||Apr 8, 13Apr ’13||275||•|
|blogMeanwhile, backstage+ |
Meanwhile, backstage: Another audio article completed this afternoon. That’s three now! I’ll be publishing them soon, so stay tuned for that. Two more to go, I think, and then it’s back to recording several more audio books.
I’ve also been spring data cleaning! Prepping for the next several years of writing, I’ve purged roughly 10,000 lines of “cruft” (junky data) out of my bibliographic database … leaving >40,000 lines and thousands of much tidier records.
|Apr 8, 13Apr ’13||75||•|
|blogI dare ya+ |
I dare ya: “Try working in a hospital for a while, try to be perfect, try to never have anything go wrong that matters!” This article freshened up a bit…
|Apr 8, 13Apr ’13||30||•|
|What can a runner with knee pain do at the gym? Some gym training options and considerations for runners (and others) with overuse injuries of the knee||Apr 6, 13Apr ’13||2,100||•••|
|blogTissue pathology does not explain chronic pain+ |
Source: Dr. Lorimer Moseley, Teaching people about pain — why do we keep beating around the bush?
|Apr 5, 13Apr ’13||35||•|
|blogDisc, schmisc+ |
Patients with back pain and sciatica recovered about equally well with or without disc herniations visible on MRI. Most people recovered (84%) well within a year … and there were actually 2% more good outcomes in the patients with disc herniations! This seems like a rather surprising result, but that is what the research has been showing for years. There is a chance the nearly identical stats are a fluke, but they’d have to be off by a lot to change the take-home message. Even a 20-point difference, ten times larger than this, would still show that a “slipped disc” confirmed by MRI isn’t nearly as worrisome as most people assume.
|Apr 4, 13Apr ’13||110||•|
|blogUnicorn horn velvet!+||Apr 3, 13Apr ’13||45||•|
|blog1-Minute fibromyalgia video+ |
Fibromyalgia is “widespread pain for three months with no other identifiable cause,” which is just as awful as it sounds. 2% of people suffer from it (that’s a lot), but in an odd and unexplained ratio of 9 female patients for every male. Here’s a good new one-minute video summary from Dr. Rob of One-Minute Medical School:
|Apr 2, 13Apr ’13||55||•|
|blogSeven amusing alternatives to evidence-based medicine||Apr 1, 13Apr ’13||180||•|
|Why “Science”-Based Instead of “Evidence”-Based? The rationale for making medicine more science-based||Apr 1, 13Apr ’13||2,200||•••|
|Voltaren® Gel+Made available in North America only quite recently, Voltaren® Gel is a particularly safe and useful medicine that many people here have still not heard about. It’s a topical anti-inflammatory medication, so it can be applied only where you need it, instead of soaking your entire system with medication, avoiding or minimizing common side effects like indigestion, and some serious safety concerns associated with the oral version of the drug. It’s FDA-approved to treat osteoarthritis in “joints amenable to topical treatment, such as the knees and those of the hands,” but it probably also works for some other painful problems, such as some repetitive strain injuries and back pain. The evidence shows that it “provides clinically meaningful analgesia.” So this product actually works and it gets a pass from skeptics and critics — a rare thing indeed in the world of pain treatments! A useful rub-on anti-inflammatory medication||Mar 29, 13Mar ’13||2,200||•••|
|Pain & Injury Survival Tips Dozens of ideas for evidence-based rehabilitation and self-treatment for common pain problems and injuries||Mar 29, 13Mar ’13||9,500||••••|
|blogElectric baths||Mar 28, 13Mar ’13||170||•|
|blogSpinal infection?||Mar 26, 13Mar ’13||220||•|
|blogUpdated Tissue Provocation Therapies+ |
Updated my article about Tissue Provocation Therapies. The update was inspired by a new article by Leonard Van Gelder, a “huge proponent” of Instrument Assisted Soft Tissue Mobilization (IASTM, like Graston). It’s a decent critical review of IASTM, with some fairly harsh words, but it also rests on a foundation of classic error: certainty that a treatment really works. It doesn’t take much reading at TestingTreatments.org (see previous post) to realize that it’s actually impossible to know if a something works based on clinical observations alone. Repeat after me:
“I will not claim to know what treatments really work for pain before they are properly tested.”
“I will not claim to know what treatments really work for pain before they are properly tested.”
“I will not claim to know what treatments really work for pain before they are properly tested.”
|Mar 22, 13Mar ’13||130||•|
|blogTesting Treatments+ |
Testing Treatments continues to grow & improve, and it was great to begin with. It looks like quite a few new tools and features have been added to the site over the last year. It’s a really terrific resource, maybe even the single best place for professionals to start learning about evidence-based medicine.
|Mar 22, 13Mar ’13||50||•|
|blogA boast post+ |
As of Monday, SaveYourself.ca now reaches more than 10,000 visitors every day … with great reading time statistics. People who come to SaveYourself.ca stay and read.
|Mar 20, 13Mar ’13||25||•|
|blogClinical Decision-Making+ |
Clinical Decision-Making Part III from ScienceBasedMedicine.org: fairly heavy professional reading, but gooood. Dr. Novella is an extremely clear thinker and writer.
|Mar 20, 13Mar ’13||20||•|
|blogStretching for trigger points+ |
More about trigger points today: skeptical revision of Stretching for Trigger Points points out many problems in theory & practice (understatement).
|Mar 18, 13Mar ’13||15||•|
|blogMore than placebo, less than medicine+ |
|Mar 18, 13Mar ’13||70||•|
|blogTopical NSAID risks much lower than oral||Mar 15, 13Mar ’13||180||•|
|blogImpruvism.com podcast+ |
I was interviewed about back pain myths by Armi Legge for the Impruvism.com podcast.
|Mar 15, 13Mar ’13||10||•|
|blogOne of my favourite history of medicine stories+ |
It’s the 200th birthday of John Snow, the father of epidemiology, the science of diseases and how they spread. In 1854, Snow mapped cases of cholera and traced the disease to its origin, and proved with a simple test that it was coming from a polluted well: he removed the pump handle, and the cholera outbreak stopped. Naturally, this conclusion was scoffed at by those with competing theories (“bad air”), producing one of my favourite history of medicine stories: to prove that cholera was not in the water, some smartypants biologist drank a glass of the stuff … and got away with it, because he just happened to be immune. It’s a great example of why “experience” is not trustworthy, and why it takes so long to settle even relatively straightforward puzzles in medicine.
|Mar 14, 13Mar ’13||130||•|
Why am I so “negative”? I am often asked this. There are many answers, and the most important has always been that I value truth-telling in health care for its own sake, even if it’s disappointing, and unfortunately a lot of it is. Here’s a nice quote from author Chris Brogan that gives another nice answer: “To truly know what works, you have to learn what doesn’t work first.”
|Mar 13, 13Mar ’13||65||•|
|blogRevenge of the Woo+ |
Dr. Steven Novella’s entertaining report on a weird paper in which some acupuncturists “grossly mischaracterize their critics and manage to completely avoid the substance of our criticism.” See also his follow-up post the next day, Another Acupuncture Meta-Analysis — Low Back Pain, summarized thusly: “1 — Acupuncture does not work. 2 — Acupuncturists refuse to admit that acupuncture does not work.”
|Mar 13, 13Mar ’13||60||•|
|blogTissue state is just chemistry||Mar 13, 13Mar ’13||150||•|
|blogPelvic tilt+ |
Pelvic tilt is one of the great biomechanical bogeymen, one of those things that gets blamed for a lot of pain and is the justification for a lot of massage and chiropractic therapy. I was taught in school to judge pelvic tilt by measuring the pointy bits. It all seemed very technical. And yet, as I always suspected, pelvic shape is simply much too variable to diagnose pelvic tilt by feel. The shape can vary as much as the position! A new study of cadavers “found that the PSIS/ASIS angle varied from left to right (up to eleven degrees), even when the pelvis was in neutral. The asymmetrical shape of the pelvis in this respect could make it appear that one side is rotated forward compared to the other.” That’s from a superb report on the study by Todd Hargrove at BetterMovement.org:
|Mar 12, 13Mar ’13||140||•|
|blogInteresting but not awfully important epiphenoma+ |
Gray matter density changes with pain are “interesting but not awfully important epiphenoma”? Neil O’Connell for Body In Mind, with his usual sassy clarity:
|Mar 11, 13Mar ’13||20||•|
|blogAn unfortunate trivialization+ |
“The labeling of nociceptors as pain fibers was not an admirable simplification, but an unfortunate trivialization under the guise of simplification.” — Patrick Wall, 1986 (“The relationship of perceived pain to afferent nerve impulses”). Context and more for that quote in a good, short article by Moseley, “Teaching people about pain: why do we keep beating around the bush?”
|Mar 11, 13Mar ’13||50||•|
|blogTwo especially nice reader comments+ |
Nice reader comment #1: “It is obvious that you are willing to go to explanatory lengths that no one else will.” That’s a great way of putting it. That is the whole idea of feature articles and ebooks for SaveYourself.ca: deep topic diving.
Nice reader comment #2: unusually exuberant! I get a lot of “good site” and “I like the clean style,” but this fellow was really impressed:
I think he likes it. I’m not sure, but I think so. Maybe if he were slightly more enthusiastic I could tell…slug:2 nice reader comments
|Mar 11, 13Mar ’13||120||•|
|blogIntroducing the microblog||Mar 8, 13Mar ’13||200||•|
|blogSeriously, funny salt+ |
No joke: my Epsom salts article is now funnier. Whimsy added where possible, for example the paragraph about vaginal absorption:
|Mar 8, 13Mar ’13||75||•|
|blogBig fascia update+ |
|Mar 1, 13Mar ’13||45||•|
Some nice dissection-perspective on connective tissue and stretching here. (And some kind words about SaveYourself.ca as well—thanks, John Underdown of TailoredPT.com.)
|Feb 27, 13Feb ’13||20||•|
|blogGlucosaminimal+||Feb 26, 13Feb ’13||25||•|
|blogPosture is a hit!+ |
Like-new posture article has been a big viral hit last 2 weeks: more than I expected. If you missed that news, see:
|Feb 26, 13Feb ’13||20||•|
|blogSexy mental fitness+ |
Another terrific quote from Sam Kean’s very charming 2012 book about genetics, The Violinist’s Thumb. Not super on-topic for SaveYourself.ca … but I still think a lot of you will love it.
|Feb 26, 13Feb ’13||85||•|
|Stretching for Trigger Points Is “muscle knot” release a good reason to stretch?||Feb 25, 13Feb ’13||1,700||•••|
Fred Wolfe on The Fibromyalgia Perplex: “It is discovered that the true meaning of fibromyalgia is not as simple as is usually believed.” Boy, no kidding. I have now read FMPerplex.com “cover to cover,” so to speak. I like Dr. Wolfe’s style, and I’ve learned a fair bit (and updated the introduction to my muscle pain tutorial). Here’s a recommended post:
|Feb 19, 13Feb ’13||55||•|
|Thixotropy is Nifty, but It’s Not Therapy+Thixotropy is the property of some gels or fluids that are normally thick (viscous), but thin when they are stressed. In the human body, the synovial fluid that lubricates most joints is thixotropic, as is the gelatinous “ground substance,” which is part of all connective tissues such as tendons and ligaments. (Fun fact: semen is also thixotropic.) Thixotropy is one of the reasons that we loosen up a little as we move around, just like engine oil warming up. However, thixotropic effect is not a therapeutic effect, and does not explain “releases” in massage or fascial therapy: it is too minor, slow, and temporary, and connective tissue is too tough. A curious property of connective tissue is often claimed as a therapy||Feb 19, 13Feb ’13||750||••|
|blogStretching good for the heart+ |
A strange idea? Or maybe it’s just obvious that lots of somatic sensation is regulatory. A study finds “stretching routines may contribute to a favorable autonomic activity change…” Study:
|Feb 16, 13Feb ’13||25||•|
|blogGood massage news+ |
|Feb 16, 13Feb ’13||15||•|
|Help for Anxiety Anxiety doesn’t respond to logic and reason, so what does it respond to?||Feb 14, 13Feb ’13||2,500||•••|
|SSRI Antidepressants Are Not Medicine Frightening side effects, cover-ups on the record, and no reason to believe they do what they are supposed to||Feb 14, 13Feb ’13||3,000||••••|
|blogBig boner+ |
The naturalistic fallacy: “One of the biggest boners in ethical philosophy.” Another terrific quote from Sam Kean’s very charming 2012 book about genetics, The Violinist’s Thumb. This is relevant to natural/barefoot running. Full quote:
|Feb 13, 13Feb ’13||130||•|
|blogMorgan Schmorgan+||Feb 12, 13Feb ’13||10||•|
|blog1,001 followers+ |
1,001 followers of my Twitter account! :-) I guess I’ll keep tweetin’.
|Feb 12, 13Feb ’13||10||•|
|blogPosture reactions+ |
I had 997 followers this morning. Then I started trash-tweeting the clinical importance of posture. Now I have 994. Some say I’ve been too hard on posture importance, some say not hard enough! I lean towards “not enough.” Best criticism of my posture article so far? I don’t mention potential for nocebo & unintended consequences of advice [Now corrected]. Belief in postural dysfunctional can probably drive a nocebo + spinoff beliefs about vulnerability + harmful zeal for “correction.”
|Feb 11, 13Feb ’13||75||•|
“Posturology” is the cheesy, popular term for the mostly made-up “discipline” of studying the relationship between posture and pain, and even diseases. Posturologists (I can barely write that with a straight face) tend to assume their own conclusion: they just take it for granted that poor posture does cause pain and then look for confirmation. And so there are many, many scientific papers that seem to present evidence of a connection between posture and pain, but most of them suck (see Guimond et al for a good example) and “posturology” is mostly a slummy pseudoscientific research backwater. There may actually be something to learn, if only posturology research was better quality, but most of it has to be just chucked or at least taken with a huge grain of salt.
|Feb 11, 13Feb ’13||120||•|
I only critisize someone’s communiation skills when their writeing problem are signicifant and revelant!
|Feb 9, 13Feb ’13||10||•|
|blogNew massage myth+ |
A year ago we got a new massage myth: “reduces inflammation & promotes mitochondria.” Bollocks. Here’s what I wrote:
|Feb 8, 13Feb ’13||15||•|
|blogAffective massage therapy+ |
Want some good science news about massage therapy? Okay! Massage clearly reduces anxiety & depression. Great article about what massage does for “an individual’s feelings, moods and emotions”:
|Feb 8, 13Feb ’13||25||•|
|blogCleaner, sparklier+ |
SaveYourself.ca is now routinely professionally edited — even cleaner, sparklier articles — by JoAnne Dyer of Seven Madronas Communications.
|Feb 8, 13Feb ’13||15||•|
|blogTwo Audiobooks Now Available||Feb 4, 13Feb ’13||250||•|
|blogUnstable? Unreliable+ |
You can’t very well treat core instability if you can’t diagnose it as a problem in the first place. This test of the reliability of core strength testing was a clear failure: “6 clinical core stability tests are not reliable when a 4-point visual scoring assessment is used.” Even if core strength is important (a separate question), this evidence clearly shows that no one should be claiming to be able to detect a problem with core weakness in the first place. A bit problematic for core dogma.
Just added this citation to my article about reliability studies—it's a really good example of poor reliability. Later I will add it to a half dozen more articles.
|Feb 4, 13Feb ’13||110||•|
|blogDiagnostic reliability+ |
“Gunshot wound diagnosis is reliable.” From: Is Diagnosis for Pain Problems Reliable?
|Feb 4, 13Feb ’13||7||•|
|blogComic back cracking+||Feb 4, 13Feb ’13||25||•|
|blogHope springs eternal+ |
“What’s the best solution?” I get this question constantly. There’s no “best solution” for any hard pain problem … only a few imperfect options.
|Feb 3, 13Feb ’13||20||•|
|blogI don’t know if you gots it+ |
Reader question of the week: “Do i got the IT band syndrome?”
(An ESL reader, to be fair. Regardless, it’s beyond me why people think I can diagnose by email.)
|Feb 3, 13Feb ’13||25||•|
|blogKind customer feedback+ |
Kind customer feedback of the week: “Thank you for a very edifying yet witty tutorial.” Referring to my e-book:
|Feb 2, 13Feb ’13||15||•|
|blogBarefoot understatement+ |
The discovery of barefoot heel-strikers adds to “lack of certainty about what makes for ideal running form.” From a NY Times article, “Is There One Right Way to Run?”
|Feb 2, 13Feb ’13||25||•|
|blogA common problem+ |
“My chiropractor says this is because the top of my neck attaches to my head. Is that a common problem?” ~ Doc Grumpy
|Jan 31, 13Jan ’13||20||•|
|blogUltrasound update+ |
|Jan 28, 13Jan ’13||30||•|
|blogMany people believe+ |
One thing about my job: I get a lot of email from patients everywhere…a constant, endless, informal survey of treatment practices and prevalent ideas. This allows me to write things like “many people believe” with some authority. I actually do know better than, say, the average clinician.
|Jan 28, 13Jan ’13||45||•|
|Does Spinal Manipulative Therapy (SMT) Work?+
The idea of “adjusting” the spine refers to many different manual therapies that wiggle, pop and otherwise manipulate spinal joints. The correct umbrella term for these treatments is “spinal manipulative therapy” or SMT. Expert opinions on SMT range widely, with some prominent medical scientists expressing strong concern and skepticism. Its provenance in chiropractic subluxation theory is dubious, its benefits are minor at best, and yet there are serious risks, even including paralysis and death in the case of SMT for the joints of the neck.
Despite all the controversy, there has been little high quality scientific research to determine whether or not SMT is safe and really works. Major science reviews have either been thoroughly discouraging. Thus, SMT fails the “impress me” test — it can’t possibly be working any miracles.
And yet spinal joint popping in particular is something that people crave, and most clinicians believe that some forms of SMT can be helpful to some of their patients, some of the time. There seems to be almost no doubt that there is something of therapeutic interest going on in SMT, at least some of the time.Adjustment, manipulation, and popping of the spinal joints and the subluxation theory of disease, back pain and neck pain
|Jan 25, 13Jan ’13||12,000||•••••|
|blogKinesio tape+ |
Shocker: science sez applying kinesio tape had no effect on muscle strength. Daft idea to begin with. See Vercelli et al.
Fun fact: an image Search for “kinesio taping” gets lots of SEXY shots. Huh! Ladies, many of one particularly hot male model. Yow yow!
|Jan 24, 13Jan ’13||40||•|
|blogI can relate+ |
Reader finds my insomnia article Googling “when does sleep deprivation become lethal.” I can relate to that question.
|Jan 22, 13Jan ’13||15||•|
|blogCreatine-induced insomnia||Jan 19, 13Jan ’13||250||•|
|blogNow that’s ankle flexion+ |
“They can get their foot almost 45˚ to the shin. (Normal range of motion for a westerner is ~10-20˚).” ~ Todd Hargrove
|Jan 19, 13Jan ’13||20||•|
|blogCrappy acupuncture reviews+ |
“…most systematic reviews of acupuncture published in China don’t search the literature thoroughly & don’t evaluate it properly. … There is ample reason to be suspicious of the conclusions of [Chinese] systematic reviews [of acupuncture].”
|Jan 18, 13Jan ’13||35||•|
|blogPainless dislocated … neck?+ |
Case report & disturbing X-ray of a traumatic neck dislocation… mostly asymptomatic. Even very serious injuries can cause amazingly little pain. Fascinating!
|Jan 18, 13Jan ’13||20||•|
|blogExploding head syndrome+ |
I will have to look into “Exploding head syndrome.” Plus a couple others. 13 weird studies.
|Jan 18, 13Jan ’13||15||•|
|Do Epsom Salts Work?+Epsom salt in your bath is cheap and harmless and it makes bath water feel “silkier,” so there’s no reason to ban it from your life. However, it probably doesn’t do what you hope it’s doing. Although Epsom salt probably does have some physiological effects, it is unknown if there is a therapeutic effect on aches and pains … and somewhat unlikely. Most of the theories you hear are oversimplified and meaningless — for instance, nearly everyone says it is absorbed by osmosis, but that is false and impossible — and the known effects of Epsom salt don’t have much to do with common causes of pain. The heat of a nice bath is probably more therapeutic. The case for the healing powers of Epsom salt is mostly made by people selling the stuff, or recommending it as casually and imprecisely as an old wives’ tale. There is no good reason to believe that Epsom salt baths aid recovery from muscle pain, soreness or injury||Jan 16, 13Jan ’13||8,000||••••|
|blogChange how it feels+ |
Change how it feels: “novel sensory input.” One of the new pain tips:
|Jan 14, 13Jan ’13||10||•|
|blogSensory clutter+ |
“Sensory clutter”: I don’t know how yet, but soon I will find a way to use these words. (Update: I still haven’t! But I will!)
|Jan 13, 13Jan ’13||25||•|
|blogKnee lube jobs+||Jan 12, 13Jan ’13||30||•|
|blogHonest fan mail+ |
Honest fan mail: “The honesty of your articles is freaking fantastic.”
I do try to avoid dishonesty!
|Jan 12, 13Jan ’13||15||•|
|blogHealing speed+ |
It’s usually not possible to tell if a treatment made healing “faster.” There are few ways or none to actually improve on the biological process of healing. We can’t tell the body, “Hey, heal better, will ya?”
|Jan 12, 13Jan ’13||35||•|
AllTrials.net is trying make sure ALL research results are reported—not just results that make drugs look good. I’ve signed the AllTrials.net petition & donated. Here’s my petition statement:
|Jan 10, 13Jan ’13||90||•|
|blogMinute Medical School||Jan 8, 13Jan ’13||190||•|
|blogI Ain’t Just Book Smart!+ |
I have lived & loved many of the flaky & sloppy ideas in health care that I criticize and debunk today. I’ve added more information about my background to my bio page.
|Jan 7, 13Jan ’13||30||•|
|blogThis will sting a little bit+ |
|Jan 6, 13Jan ’13||25||•|
|blogStretching doesn’t help contracture+ |
Thumbs down to simple #stretching as a treatment for seizing up.
|Dec 31, 12Dec ’12||10||•|
|blogBlogging the process+ |
I’ve written 424 blog posts (roughly 175,000 words) since I started “blogging the process” about two years ago — that is, as I go through the process of creating very detailed articles and tutorials, I share bits and pieces of what I’m working on as I go, using a blog format. So my blog posts are all in some sense excerpts or rough drafts of larger projects. I very roughly estimate that I actually wrote more than double that much, but only blogged about 175,000 words.
|Dec 31, 12Dec ’12||85||•|
I’d never heard “anecdata” before. Cute.
|Dec 28, 12Dec ’12||6||•|
|blogBrains control pain… not minds+ |
Still working this idea, finding every angle: brains control pain… not minds. It’s a subtle but vital difference.
|Dec 26, 12Dec ’12||15||•|
|blogA few thoughts on the limits of self-care||Dec 26, 12Dec ’12||240||•|
|Popular but Weird and Dangerous Cures+
The colorful history of medicine and quackery is overflowing with people who “swore by” treatments that were bizarre and dangerous. Bloodletting was popular almost until the 20th century, despite being relentlessly harmful. Some of the most lethal “cures” in history were inspired by the discovery of radiation. People happily drank metals like mercury and silver. Even drinking urine had near fad status for a while! They tried to purge disease with sulfuric acid, and stimulate their vitality (and virility) with powerful electric shocks. Women were sold Lysol as a douche … and women actually went along with it for a while. Voluntary lobotomy may be the craziest of them all: it was a popular treatment for all kinds of psychiatric disorders, and at least fifty thousand people volunteered to have their brains lanced.
All of these terrible treatments, and many more obscure examples, had many fans and enthusiastic testimonials. People paid for them, believed in them, loved them, swore by them — that is how misleading testimonials can be. People believe what they want to believe.The most dangerous, strange and yet popular snake oils and “treatments” in history, and why anecdotes and testimonials cannot be trusted
|Dec 19, 12Dec ’12||750||••|
|Should You Get A Lube Job for Your Arthritic Knee? Reviewing the science of injecting artificial synovial fluid||Dec 18, 12Dec ’12||700||••|
|blogI’m sorry, Creatine, I misjudged you+ |
|Dec 10, 12Dec ’12||20||•|
|blogReston was not anaesthetized by acupuncture||Dec 8, 12Dec ’12||160||•|
|blogFeel safe & good+ |
Therapists: please consider not trying to “fix” flesh. Address the nervous system. Just help patients remember what it’s like to feel safe & good.
|Dec 6, 12Dec ’12||20||•|
|blogEBM appearances+ |
Now here’s a good example of how EBM gets abused, co-opted: “appearing to build up the evidence base.” Context here from @doctordoubter:
|Dec 6, 12Dec ’12||20||•|
|blogPlacebo surgeries+ |
You “need a placebo [surgery] trial when the outcomes are ‘soft’ (subjective: pain).” ~@doctordoubter Placebo surgeries are necessary and ethical. I’ve been arguing many years we need surgeries for pain compared to shams. More:
|Dec 5, 12Dec ’12||30||•|
|blogHow important is sleep?+||Dec 4, 12Dec ’12||20||•|
|blogPNF stretching+ |
Static stretching vs. “fancy” PNF stretching: which works better? Hold-relax, right?
It’s common for stretching enthusiasts to dismiss my concern that stretching is not all that useful with the concession that, of course, static stretching is quite pointless, but fancier methods (their methods) are “obviously” clinically useful. By far the most common example of allegedly superior stretching is the broad category of “proprioceptive neuromuscular facilitation,” and more specifically the hold relax method. Supposedly this approach works better than mere pulling on muscle. However, this test of the immediate effects HR-PNF versus static stretch on hamstrings was a bust: they both increased flexibility equally well (for whatever that’s worth).
|Dec 3, 12Dec ’12||130||•|
|blogSBM’s about page+ |
My role at ScienceBasedMedicine.org is basic…but I did write their about page. And I am proud of that. (And everything I’ve ever written about SBM is just my take on what I’ve learned from Drs. Novella, Gorski, Atwood, Crislip, Hall…)
|Dec 3, 12Dec ’12||40||•|
|Does Acupuncture Work for Pain? A review of modern acupuncture evidence and myths, particularly with regards to treating low back pain and other common pain problems||Nov 10, 12Nov ’12||6,000||••••|
|Deep Friction Massage Therapy for Tendonitis A guide to a simple self-massage technique sometimes helpful in treating common tendonitis injuries like tennis elbow or Achilles tendonitis||Nov 9, 12Nov ’12||2,400||•••|
|Unconventional Ergonomics Five creative ergonomics tips you don’t hear as much about as the usual stuff||Nov 3, 12Nov ’12||1,100||•••|
|Should You Drink Water After Massage? Only if you’re thirsty! Hydration and massage are not detoxification treatments||Nov 2, 12Nov ’12||4,000||••••|
|Natural Imperfection Evolution doesn’t care if you have back pain … just as long as you can breed||Nov 1, 12Nov ’12||4,000||••••|
|Massage Therapy for Tension Headaches Perfect Spot No. 1, in the suboccipital muscles of the neck||Oct 28, 12Oct ’12||1,500||•••|
|Don’t Stretch Your IT Band! Despite the popularity of Iliotibial Band stretching as a treatment for IT band syndrome, there is no scientific or anatomical reason to believe that any kind of IT band stretch is even possible, let alone an effective treatment — so, what does work?||Oct 27, 12Oct ’12||2,300||•••|
|(Almost) Never Use Ice on Low Back Pain! An important exception to conventional wisdom about icing and heating||Oct 27, 12Oct ’12||3,500||••••|
|Massage Therapy for Shin Splints Perfect Spot No. 3, in the tibialis anterior muscle of the shin||Oct 27, 12Oct ’12||1,500||•••|
|Insomnia Until it Hurts The role of sleep deprivation in muscle pain and other kinds of chronic pain||Oct 26, 12Oct ’12||2,750||•••|
|Massage Therapy for Upper Back Pain Perfect Area No. 11, the erector spinae muscle group of the upper back||Oct 26, 12Oct ’12||1,000||•••|
|Massage Therapy for Tired Feet (and Plantar Fasciitis!) Perfect Spot No. 10, in the arch muscles of the foot||Oct 25, 12Oct ’12||1,000||•••|
|blogPoisoning humour+ |
entire biggish article about rhabdomyolysis.
|Oct 21, 12Oct ’12||15||•|
|blogThe unkillable lactic acid myth+ |
Lactic acid is not a dead-end, “bad” metabolic waste product, and it does not cause post-exercise soreness. This is a pernicious and seemingly un-killable myth. It originated with “one of the classic mistakes in the history of science,” according to George Brooks, a Berkley physiologist. See Gina Kolata’s clear overview in the New York Times, or a concise professional summary by Robergs in Experimental Phsyiology. For a deeper and geekier, but excellent read, see Dr. Goodwin’s entertaining rant about the prevalence of the lactate myth in the 2012 summer Olympics coverage.
|Oct 21, 12Oct ’12||90||•|
|blogSurgeon corrects my tone||Oct 21, 12Oct ’12||170||•|
|blogRadiological imagining+ |
“It is recommended that radiological imagining should continue to be used.” Indeed! That would be quite good at getting results, I imagine.
|Oct 21, 12Oct ’12||20||•|
|Basic Self-Massage Tips for Myofascial Trigger Points Learn how to massage your own trigger points (muscle knots)||Oct 20, 12Oct ’12||1,700||•••|
|Water Fever and the Fear of Chronic Dehydration Do we really need eight glasses of water per day?||Oct 13, 12Oct ’12||2,500||•••|
|When To Worry About Shortness of Breath … and When Not To+Difficulty breathing is a common complaint and a tough diagnostic challenge, and there are some serious causes to be aware of. However, many cases are probably caused by minor and treatable muscle knots, respiratory dysfunction and/or weakness. Relief may be relatively easy for some patients. It’s safe and cheap to experiment with self-massage for muscular trigger points. And, although changing bad habits is always tricky, increasing your respiratory strength is definitely effective and a worthwhile fitness goal in any case. Some common, minor & treatable causes of a scary symptom explained||Oct 12, 12Oct ’12||3,000||••••|
|Thickened plantar fascia — really thick! Science confirms connection between plantar fasciitis and a surprisingly thick tissue in the arch of the foot||Oct 8, 12Oct ’12||275||•|
|Contrast Hydrotherapy Exercising tissues with quick temperature changes for injury recovery, especially repetitive strain injuries||Oct 8, 12Oct ’12||2,500||•••|
|Does Arnica Cream Work for Pain?+
Homeopathic (diluted) herbal ointments for inflammatory pain, like muscle pain, joint pain, sports injuries and bruising, are quite popular, but their effectiveness is fairly questioned by many. Known to most customers as “herbal” arnica cream, most contain less than 10 micrograms of arnica per dose — dramatically less that what is needed of most substances to be considered a chemically active ingredient. Homeopathy is based on an exotic interpretation of physics that involves diluting ingredients to the point of completely removing them. Some of the herbal ingredients are less diluted and may be chemically active and more useful.
A few tests of homeopathic pain creams have been mildly encouraging, but mostly old and poor quality ones. In all good quality, modern scientific trials so far, they seem to do no better than placebo. It is possible that a benefit can still be proven, but it is not likely.A detailed review of popular homeopathic (diluted) herbal creams like Traumeel, used for muscle pain, joint pain, sports injuries, bruising, and post-surgical inflammation
|Oct 2, 12Oct ’12||9,000||••••|
|The Unstretchables Eleven major muscles you can’t stretch, no matter how hard you try||Oct 2, 12Oct ’12||2,000||•••|
|Massage Therapy for Your Quads Perfect Spot No. 8, another one for runners, the distal vastus lateralis of the quadriceps group||Oct 2, 12Oct ’12||1,500||•••|
|What Happened To My Barber? Either atlantoaxial instability or vertebrobasilar insufficiency causes severe dizziness and vomiting after massage therapy, with lessons for health care consumers||Sep 28, 12Sep ’12||2,750||•••|
This sentiment is heard all too often in alternative medicine: “We need some science to prove how treatment modality X works!” No! No no no! That is bass-ackwards. It’s a terrible inspiration for doing science, guaranteed to dial confirmation bias up to 11.
The premise that treatment X “works” is invariably based only on clinical experience, which proves nothing and cannot be trusted. Treatment efficacy must be actually tested and proven rigorously first. We need find out if an idea actually produces measurable medical results and then — if it works, if it actually helps people enough to be measurable — then and only then do we proceed to try to illuminate the mechanism. Stated even more briefly: we cannot study how a treatment works if we haven’t figured out if it works.
“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 1892 A Scandal in Bohemia)
|Sep 19, 12Sep ’12||190||•|
|Poisoned by Massage+
Massage is not a detoxification treatment in any sense, contrary to a popular belief. Ironically, it’s the opposite: post-massage soreness and malaise (PMSM) is probably caused by mild rhabdomyolysis (“rhabdo”). True rhabdo is a medical emergency in which the kidneys are poisoned by myoglobin from muscle crush injuries. But many physical and metabolic stresses cause milder rhabdo-like states — even just intense exercise can do it, and probably massage as well. This is substantiated by a case study of acute rhabdomyolsis caused by intense massage (see Lai), by many well-documented cases of exertional or “white collar” rhabdo, and by the strong similarity between PMSM and ordinary exercise soreness. A rhabdo cocktail of waste metabolites and by-products of tissue damage is probably why we feel a bit cruddy after biological stresses and traumas — even massage, sometimes. And you can’t “flush” the rhabdo away with massage or by drinking a little extra water. PMSM is just an unavoidable mild side effect of strong massage.Rather than being “detoxifying,” massage may cause a modestly toxic situation in the body
|Jul 31, 12Jul ’12||4,500||••••|
|What could go wrong with massage? Rare but real adverse effects of massage therapy, especially “deep” massage||Jul 31, 12Jul ’12||1,700||•••|
|Medical Training Wins+
Many alternative health care professionals often claim that they are as well trained as physicians. This is not factual. Doctor’s academic training is routinely longer, and — more importantly — most of their serious learning occurs during extensive on-the-job training, where they are thrust into demanding clinical environments and supervised for years as they deal with a great variety of clinical situations and many extremely sick and hurt patients. That hands-on phase of their training is where all doctors will tell you that they became professionals — and there is nothing like it in any non-medical health care training.
|Jul 26, 12Jul ’12||100||•|
The idea of “toxins” is usually used as a tactic to scare people into buying de-toxifying snake oil of one sort or another. It’s not that there’s no such thing as a toxin — obviously there are toxic substances in the environment. The problem is the kind of people who toss the idea around, the reasons they do it (profit), and the total lack of any specific claim or scientific knowledge or evidence to support it. It is so vague that it’s literally meaningless, except as a marketing message. Indeed, “detoxification” may be the single most common marketing buzzword in alternative health care, and yet exactly which toxins we’re talking about, or exactly how they are disposed of, is never explained by anyone selling a product that supposedly detoxifies — because they don’t know.
The body deals with undesirable molecules in many ways. It eliminates some and recycles others; some are trapped in a safe place; and quite a few can’t be safely handled at all (metals). Most alleged “detox” treatments are focussed on stimulating an excretion pathway, like sweating in a sauna. But it’s not like sweating is broken and the sauna is fixing it! The only truly “detoxifying” treatments help the body eliminate or disarm molecules the body cannot process on its own. A stomach pump for someone with alcohol poisoning is literally “detoxifying.” So are chelation for heavy metals, and antivenoms.
I cover the specific idea of “flushing” toxins in Should You Drink Water After Massage? (Massage is wonderful for all kinds of reasons — it doesn’t need the support of the idea that it detoxifies.) For more general consumer advocacy and education about toxins, see “Detoxification” Schemes and Scams (from QuackWatch.org).
|Jul 26, 12Jul ’12||275||•|
|blogBad Science Watch||Jul 12, 12Jul ’12||170||•|
|You’re Really Tight The three most common words in massage therapy are pointless||Jul 4, 12Jul ’12||1,600||•••|
|Masking Symptoms Is Under-Rated+
“Masking symptoms,” especially with medications, is often maligned because it doesn’t “aid healing” or “treat the root cause.” But masking symptoms can be a perfectly good idea, and it should not be eschewed just because it doesn’t have a real healing effect … because there are very few real healing effects! Maybe none. There are few or no known ways to actually improve on the biological process of healing. We can’t tell the body, “Hey, heal better, will ya?”
“Healing” is mainly about removing impediments to natural recovery, such as continued overuse and excessive stress. It’s not dictated by some mythical power to speed healing, but by a strong understanding of the nature of the problem and what pisses it off and slows recovery. The most idiotically simple example is that bad sprains need to be immobilized for a while, just like a fracture — and maybe that seems “obvious,” but it was actually common practice for decades to recommend excessive early mobilization.
Here’s a classic, trickier example: patellofemoral pain is often misdiagnosed and “treated” with strength training that tends to stress the knee even more, and yet it often works to simply avoid sitting with bent knees, because that position is more biomechanically “intense” than most patients realize. Removing that sneaky knee stress isn’t “healing,” per se, but it’s sure important!
Focus on facilitating natural recovery, and don’t knock a little “symptom relief” along the way.
|Jul 2, 12Jul ’12||250||•|
|Massage Therapy for Shoulder Pain Perfect Spot No. 14, The Most Predictable Unsuspected Cause of Shoulder Pain||Jun 25, 12Jun ’12||1,500||•••|
Confirmation bias explains a lot about human nature. Most people know it best as “selective hearing” or “selective memory” — hearing and remembering only what you want to hear (see also “pareidolia”). Confirmation bias is a whole lot more: a dazzling array of devious and largely unconscious mental tactics and thinking glitches that lead people to confirm their beliefs and pet theories. We not only tend to ignore, deny and overlook anything that contradicts our point of view, but we also invariably notice, inflate and or even fabricate anything that supports it.
Confirmation bias is one of the main reasons that The Truth is so slippery, and both amateurs and experts alike are prone to significant thinking errors. There are people who consider it part of their job description to eliminate confirmation bias from their thinking — the best scientists and journalists, for instance — but it’s really difficult. Everyone has confirmation bias: it’s just how minds (don’t) work!
|Jun 22, 12Jun ’12||180||•|
|What’s a Claim?+
A claim is any unverified assertion. But not all claims are created equal. In health care and health science, “claim” implies a more self-serving assertion. If a claim could be used as a bullet-point in a sales pitch, it’s more claim-y. If it makes you (or your profession) look better, it’s more claim-y. And the more claim-y it is, the more it needs to be backed up.
This special case of the word claim comes from the thorny ethical challenges with selling care to sick, hurt people. All claims need skepticism and verification, but it’s just not as ethically critical if it has no claim-stink. Sagan’s law that “extraordinary claims require extraordinary evidence” is also, in spirit, about more mundane but self-serving and profitable claims — a more common ethical hazard than “extraordinary” claims.
|Jun 21, 12Jun ’12||140||•|
There can certainly be something wrong with your spinal joints — there are a few possibilities — but “subluxation” and spinal joints being “out” are not defined clearly enough to be useful, and are probably quite misleading.
“Subluxation” is mainly a chiropractic idea of spinal joint dysfunction, with many shades of meaning — too many — depending on who is talking about it. However, it is inextricably entangled with the idea of a spinal joint being “out” of place, and it is this sense of the word that needs some debunking. Chiropractors attribute great importance to subluxation. Most believe that subluxations cause neck and back pain, and — significantly — many also believe that they cause a wide variety of other health problems and so they “use spinal manipulation to treat visceral disease” (Homola). Subluxation theory has been both popular and controversial for many decades now, and it has never achieved medical respectability. Many experts, including quite a few chiropractors, actually deny that spinal subluxations exist in any meaningful sense.
It’s problematic that spinal manipulative therapy — the umbrella term for all kinds of spinal joint “adjustment” — is so often based on such a confusing and controversial concept. Subluxation has too much baggage to be a useful term. Let’s use more modern and specific terminology, and get away from the idea of spinal joints being “out.”
|Jun 21, 12Jun ’12||240||•|
|The Simon Singh Story and British Libel Reform+
Simon Lehna Singh’s story is now the most famous example of legal bullying of a science writer for commenting on controversial health care. It has had important consequences for free speech, and great significance to me because I was being legally bullied for similar reasons at the same time.
Simon Singh criticized the British Chiropractic Association for endorsing spinal adjustment for children with conditions like asthma and ear infections, calling it bogus and pointing out the lack of evidence. The BCA sued, exploiting Britain’s nasty libel laws, which bizarrely require defendants to prove themselves innocent at fantastic expense. The case got off to a rough start for free speech with a ruling that Singh could not rely on his only realistic hope, the “fair comment” defence. Nevertheless, Simon appealed and the case became a public relations disaster for the BCA. On April 1, 2010, Simon Singh won his appeal, and the BCA withdrew its lawsuit.
The case catalysed a major on-going campaign to reform British libel law and put an end to the phenomenon of “libel tourism” — corporations suing their critics around the world in Britain, exploiting crazy laws that favour them there. A science writer should be able to comment on genuine concerns on an important public health issue (such as correct treatment for children) without the threat and expense of British High Court libel claims. The cost of an opinion about a controversial health care issue should not be ruinous. In the words of Frank Frizelle: “Let’s hear your evidence, not your legal muscle.”
|Jun 21, 12Jun ’12||275||•|
|Missing Serious Symptoms+
One of the most common and serious basic problems with alternative medicine is that ominous signs and symptoms of serious disease are often overlooked, misinterpreted, and minimized by many overconfident and under-trained “professionals.” Naturopaths, chiropractors, acupuncturists and massage therapists often have a haughty disdain for “mainstream” medicine. I have been constantly exposed to that attitude for many years now — it is much too common.
Of course doctors often also overlook problems — nobody’s perfect (see Medical Errors in Perspective). However, the chances of a doctor missing a scary diagnosis are generally far lower, and particularly so because they have vastly more experience with much sicker people (see Medical Training Wins).
|Jun 21, 12Jun ’12||120||•|
|The Medical Blind Spot for Aches and Pains+
Doctors lack the skills and knowledge to treat most common aches, pains and injury problem, especially stubborn cases, and even the best are poor substitutes for physical therapists. Many doctors are well aware of this, but some are alarmingly oblivious. Dr. Jonathon Tomlinson, an instructor at St. Leonards Hospital in Hoxton, explains that “undergraduate training is focused on hospital orthopedics (broken bones and anything else that’s amenable to surgery) or rheumatology (nasty inflammatory diseases) which comprise a minority of the aches/pains/strains and injuries that people actually suffer from.”
Medical researchers have done many studies showing that most doctors do not understand aches and pains or heed expert recommendations. A good recent example is a paper in the Archives of Internal Medicine showing that family doctors frequently ignore guidelines for the care of low back pain — see Williams et al.
More generally, the Journal of Bone and Joint Surgery, and the Journal of the American Osteopathic Association, have both published papers recently showing that physicians simply do not have an adequate understanding of musculoskeletal medicine. In 2002, Freedman et al felt that “It is ... reasonable to conclude that medical school preparation in musculoskeletal medicine is inadequate.” Then again in 2005 in JBJS, Matzkin et al concluded that “training in musculoskeletal medicine is inadequate in both medical school and non-orthopaedic residency training programs.” Most recently, in 2006, Stockard et al found that 82% of medical graduates “failed to demonstrate basic competency in musculoskeletal medicine.”
|Jun 21, 12Jun ’12||275||•|
|Medical Errors in Perspective+
Alternative medicine practitioners often point accusingly to medical error rates, with the implication that chiropractic, naturopathy and other alternative care is much safer. That’s probably true … in the sense that walking is much safer than driving. But if you routinely had to treat huge numbers of people with life-threatening injuries and dire illness, your profession would have scary error rates, too.
There is no question that bad things happen in hospitals, and stats about iatrogenic (doctor-generated) medical errors can seem alarming. However, to simply state that medicine kills and hurts people is misleading fear-mongering. Cars kill and hurt people too, and for pretty much the same reason: sure it’s risky, but the benefits are worth the risk, and huge numbers of people are willing to take that chance.
Medical systems deal with vastly greater numbers of much more serious cases than any chiropractor or naturopath, and many of them are no-win, rarely-win, or sometimes-lose situations with the highest stakes, terrible suffering and death. We should be cautious about criticizing that from the outside. Try working in a hospital for a while, try to be perfect, try to never have anything go wrong that matters!Medical error rates should not be used to spread fear, uncertainty and doubt
|Jun 21, 12Jun ’12||475||••|
Homeopathy is a 200-year-old medical philosophy that has been thoroughly debunked, and survives today thanks to wishful thinking, ignorance, and because it is too useless to be dangerous. It is the flagship in the alternative medicine fleet: the most popular, profitable, and absurd of all snake oils.
Most people have no idea just how strange homeopathy is. The deal-breaker for many consumers is the discovery that it’s not an “herbal” or “natural” remedy, but a “magical” one, based on a principle that reeks of flaky physics and old-timey snake oil flamboyance—much farther out in left field than herbs. Some people, of course, are quite happy citing quantum physics to explain alternative medicine, but you really have to be a card-carrying new age sort to go there. For most people, that crosses a line.
But they have to find out first! Fortunately, doctors, scientists and skeptics are unanimously and harshly critical of homeopathy, and have published many good quality critical reviews. For instance, see my own article about homeopathic arnica — the most popular of all homeopathic products, intended to treat inflammatory pain.
|Jun 21, 12Jun ’12||190||•|
Healing speed is of great interest, and people often believe that treatment X helped them to heal faster. It’s also a common marketing claim. Unfortunately, most patients aren’t the least bit knowledgeable about what constitutes a normal healing time, and should probably defer to clinicians who have seen hundreds or even thousands of examples — except that they don’t really know either, because they do know that healing time varies wildly depending on countless variables. People often recover faster or slower than expected for reasons no one can ever know. We also seem to recover faster or slower depending on which psychological “goggles” we have on (optimistic, pessimistic, etc).
The bottom line is that the natural variation in healing times tends to obscure the effects of treatments, and simply isn’t actually possible to know if any treatment helped us heal “faster,” because we can never know how long it would have taken without it. You also don’t know what will happen the next time. The only possible way to settle such questions and confirm a faster average recovery time — especially if it’s only a little bit faster — is with carefully designed scientific testing, and quite a bit of it.
|Jun 21, 12Jun ’12||210||•|
|“Reductionism” Is Not an Insult+
Alternative medicine professionals often derisively accuse their critics of being “reductionist.” It is intended to sound wise and knowing, but sneering at “reductionism” is a transparently convenient way to dismiss rational objections to crank theories and flaky bullshit — the main context in which it comes up. It’s a gripe, not a meaningful thought, about those who allegedly can’t see the forest for the trees. It insinuates a lack of vision and savvy about complex systems (like the body). This is quite ironic, coming as it usually does from barely-trained dabblers and dilettantes, people who clearly have not exactly mastered either forest or trees. (Anyone actually capable of being seeing profound patterns in complex systems would be a scientific celebrity.)
Certainly reductionism can go wrong (see Dan Dennett’s concept of “greedy reductionism”). But good reductionism — the real thing, not the insult — is just one of many thinking and reasoning tools … not an all-consuming obliviousness to “the whole.”
|Jun 21, 12Jun ’12||190||•|
|Typos & Nitpicking Hypocrisy+
Whenever I make criticasms of sloppy writing, I do open myself up to a charge of hypocrazy, because there are certainly scattered errrs on my website , probbly even on this veru page. But it’s a matter of dagree. I only critisize someone’s communiation skills when their writeing problem are signicifant and revelant: when the errors are thick and nasty and thick and nasty, when they arre combimed with style problems like SHOUTING IN CAPS!!!, or abusing “quotion marks”; or just horrible spellung and grammer and sentense structure, and and whn they betray ignoranse of the subjet matter,, like a chiropracor who writes the “veterbra” three times in the same short email and declares “I’m a proffesional”.
(I’m not making that last bit up. I actually got that message.)
Not everyone’s a writer, but writing with many glaring errors is much worse than just lacking a knack — and it exposes a lack of mental rigour and maturity. There is such a thing as a minimum literacy required for one’s ideas to be taken srsly.
|Jun 19, 12Jun ’12||190||•|
|Massage Therapy for Neck Pain, Chest Pain, Arm Pain, and Upper Back Pain Perfect Spot No. 4, an area of common trigger points in the peculiar scalene muscle group of the throat||Jun 15, 12Jun ’12||2,400||•••|
|Massage Therapy for Low Back Pain (Again) Perfect Spot No. 13, The Most Classic Low Back Pain Trigger Point||Jun 9, 12Jun ’12||700||••|
|Massage Therapy for Low Back Pain (So Low That It’s Not In the Back) Perfect Spot No. 12, a common (almost universal) trigger point in the superolateral origin of the gluteus maximus muscle||Jun 9, 12Jun ’12||2,100||•••|
|Massage Therapy for Your Pectorals Perfect Spot No. 9, in the pectoralis major muscle of the chest||Jun 9, 12Jun ’12||750||••|
|Massage Therapy for Back Pain, Hip Pain, and Sciatica Perfect Spot No. 6, an area of common trigger points in the gluteus medius and minimus muscles of the hip||Jun 9, 12Jun ’12||1,100||•••|
|Massage Therapy for Tennis Elbow and Wrist Pain Perfect Spot No. 5, in the common extensor tendon of the forearm||Jun 9, 12Jun ’12||1,300||•••|
|Massage Therapy for Low Back Pain Perfect Spot No. 2, in the thoracolumbar corner||Jun 9, 12Jun ’12||650||••|
|Eccentric Contraction+An eccentric or braking contraction is an interesting but routine type of muscular contraction that seems like a paradox: the muscle is contracting even as it is lengthening! Eccentric contraction is a bit physiologically mysterious, and is known to be harder on muscle, causing more soreness (quadriceps after hiking down a mountain is the classic example). A peculiar bit of muscle physiology||Jun 1, 12Jun ’12||700||••|
|Spinal Fracture Bracing A personal story, plus a casual tour of the science and biomechanics||May 31, 12May ’12||1,500||•••|
|The Three D’s of Quackery+When choosing treatments, please be wary of The Three D’s of Quackery: treatments that may be dangerous, dubious, and distracting (costly or time-consuming). No pain treatment is perfect, but does it at least make sense? Is it safe? Cheap? Reasonably convenient? Beware of the many Dubious, Dangerous and Distracting treatments for aches and pains||May 31, 12May ’12||1,700||•••|
|Ioannidis: Making Medical Science Look Bad Since 2005 A famous and excellent scientific paper … with a dangerously misleading title||May 9, 12May ’12||2,400||•••|
|Water Yoga 6 unusual ways to use a swimming pool for therapeutic exercise||May 7, 12May ’12||1,400||•••|
|The Respiration Connection How dysfunctional breathing might be a root cause of a variety of common upper body pain problems and injuries||May 2, 12May ’12||6,500||••••|
|Massage Therapy In British Columbia (Canada)+Massage therapy training in British Columbia, Canada, is unusually rigorous compared to most places in the world. When I trained, the requirements included a 3000-hour training program, an internship, and some very challenging certification exams. Training, credentials, and the state of the profession of massage therapy in this province||Apr 30, 12Apr ’12||950||••|
|Mobilize! Dynamic joint mobility drills are an alternative to stretching that “massages you with movement”||Apr 30, 12Apr ’12||5,500||••••|
|Oh, a flow-induced system of mechanotransduction! Of course! A century-old mystery of bone biology was solved just a little while ago||Apr 11, 12Apr ’12||475||••|
|Getting On Your Nerves Can you damage your nerves when self-massaging?||Apr 11, 12Apr ’12||600||••|
|Buyer (of Therapy) Beware All other things being equal, always choose the cheapest and most comfortable therapeutic option for your pain problem||Apr 11, 12Apr ’12||850||••|
|Bogus Citations References to “scientific evidence” are routinely misleading and scammy||Mar 10, 12Mar ’12||1,900||•••|
|Always Running the Same Way The trouble with running on concrete and asphalt||Mar 8, 12Mar ’12||1,800||•••|
|Progressive Training How to take “baby steps” to recovery from an injury or pain problem||Feb 18, 12Feb ’12||1,900||•••|
|Massage reduces inflammation and promotes mitochondria? The making of a new massage myth from a high-tech study of muscle samples after intense exercise||Feb 15, 12Feb ’12||4,000||••••|
|How Many Muscles? A (slightly tongue-in-cheek) tally of the body’s many muscles||Jan 27, 12Jan ’12||750||••|
|blogHow smart is your right foot?+ |
Warning: you may keep trying over and over again to see if you can outsmart your foot. You probably can't. This phenomenon is pretty hard-wired into your nervous system.
And there ain’t nothing you can do about it! Naturally it works with any counter-clockwise motion of the hand — “6” is just handy way of describing that.
|Dec 22, 11Dec ’11||110||•|
|Does Craniosacral Therapy Work? Craniosacral therapists make big promises, but can’t agree on diagnoses and have failed to pass fair scientific tests of efficacy||Dec 7, 11Dec ’11||1,400||•••|
|Why Do We Get Sick? The connections between poor health and the lives we lead||Dec 5, 11Dec ’11||2,000||•••|
|A Stretching Experiment What happens when you stretch your hamstrings intensely for several minutes a day in a steam room?||Nov 30, 11Nov ’11||3,750||••••|
|How I Almost Ripped My Own Head Off A cautionary tale about therapeutic stretching and the risks of self-treatment||Nov 2, 11Nov ’11||1,100||•••|
|Review of the Backnobber II & Knobble II Plus four other massage tools from the Pressure Positive Company: the Index Knobber, Jacknobber, Orbit Massager and Tiger Tail||Nov 1, 11Nov ’11||1,700||•••|
|Not So Significant After All A lot of research makes scientific evidence seem more “significant” than it is||Oct 28, 11Oct ’11||2,100||•••|
|We Are Full of Critters The human body is a colony of ten trillion co-operating cells||Oct 15, 11Oct ’11||600||••|
|Confused about the location of Iliotibial Band Syndrome? There is no such thing as “iliotibial band pain” that is not at the knee||Oct 14, 11Oct ’11||650||••|
|Microbreaking Prevent low back pain and neck cricks with lots of little breaks||Sep 17, 11Sep ’11||1,600||•••|
|Nerve Pain Is Overdiagnosed A terrific story about nerve pain that wasn’t really nerve pain||Aug 26, 11Aug ’11||650||••|
|The Pressure Question in Massage Therapy What’s the right amount of pressure to apply to your muscles in massage therapy and self-massage?||Aug 26, 11Aug ’11||3,000||••••|
|The Power of Avogadro Compels You! James Randi and Alexa Ray Joel try to poison themselves — one of them deliberately and the other accidentally making homeopathy look 10X sillier than it already did||Aug 17, 11Aug ’11||1,800||•••|
|Massage Therapy Kinda, Sorta Works for Back Pain It may work, but not particularly well, and “advanced” techniques are no better than relaxation massage||Aug 10, 11Aug ’11||4,000||••••|
|When exactly do injuries occur in walking and running? Not when you thought. Biomechanics expert Dr. Casey Kerrigan explains her surprising research results.||Jul 29, 11Jul ’11||1,000||•••|
|The Art of Bioenergetic Breathing A powerful tool for personal growth and transformation||Jun 20, 11Jun ’11||2,200||•••|
|The Humble Therapist Why you need to be skeptical when your massage therapist, physiotherapist or chiropractor tells you where the pain is really coming from||Jun 12, 11Jun ’11||2,500||•••|
|The Safety of Vitamin D for Pain Is it still safe and reasonable for chronic pain patients to take higher doses of Vitamin D? And just how high is safe?||May 7, 11May ’11||1,500||•••|
|Strength Training Surprises Why building muscle is easier, better, and more important than you thought, and its vital role in injury rehabilitation||May 6, 11May ’11||4,250||••••|
|Painful Relationships People with chronic pain face more than just medical difficulties||Apr 26, 11Apr ’11||1,200||•••|
|Review of John Sarno’s Books about Low Back Pain Essential reading for low back pain sufferers and most health care professionals||Apr 21, 11Apr ’11||1,500||•••|
|blogAn awesome ebook upgrade||Apr 20, 11Apr ’11||325||••|
|Civilization Survival Tips Coping with stress and anxiety in the modern world (without drugs)||Apr 20, 11Apr ’11||2,500||•••|
|Save Yourself From Sciatica! A basic tutorial about buttock and leg pain||Apr 17, 11Apr ’11||4,500||••••|
|Alternative to What? “Alternative” health care professionals need to decide what they are really the alternative to||Jan 14, 11Jan ’11||3,500||••••|
|Does Hip Strengthening Work for IT Band Syndrome? Despite its popularity, “weak hips” is a weak theory, and there is no compelling evidence that hip strengthening can treat or prevent running overuse injuries of leg||Dec 29, 10Dec ’10||4,250||••••|
|blogBad science writer, bad! A major mea culpa A major mea culpa||Dec 14, 10Dec ’10||400||••|
|Choose the Therapist, Not the Therapy When you’re in pain, you want to know “what works,” but what you should look for is an honest therapist of any kind||Dec 9, 10Dec ’10||1,100||•••|
|A Tour of Ideas From Recent Pain Science Pain science has advanced a great deal in the last fifty years, but most of this information has had seemingly little impact on the way pain is commonly treated||Nov 29, 10Nov ’10||1,800||•••|
|Every little thing a nice therapist does is magic Loyalty to a physical therapist is often misguided and has little or nothing to do with how well treatment is actually working||Nov 16, 10Nov ’10||650||••|
|Top journals for pain and injury science Medical journals that every physiotherapist, chiropractor, and massage therapist should be paying attention to||Oct 4, 10Oct ’10||300||••|
|Five Ways To Prevent Sports Injuries Get warm, co-ordinated, relaxed, smart and mobilized!||Oct 4, 10Oct ’10||475||••|
|Do Nerve Blocks Work for Neck Pain and Low Back Pain? Analysis of the science of stopping the pain of facet joint syndrome with nerve blocks, joint injections, and nerve ablation||Oct 1, 10Oct ’10||1,900||•••|
|The Bath Trick for Trigger Point Release A clever way of combining self-treatment techniques to self-treat your trigger points (muscle knots)||Aug 2, 10Aug ’10||600||••|
|Tennis Ball Massage for Myofascial Pain Syndrome Some creative tips on using an ordinary tennis ball and other massage tools to self-treat muscle knots and myofascial trigger points||Aug 2, 10Aug ’10||1,100||•••|
|Using Heat for Pain Problems When and how to apply heat for therapy … and when not to!||Jul 12, 10Jul ’10||1,700||•••|
|The Trigger Point Symptom Checker An interview with creator Jeff Lutz about a unique online visual database of common muscular trigger points (muscle “knots”)||May 26, 10May ’10||1,700||•••|
|Wobble Cushion Technique Instructions for chair warriors on the best usage of Disc ‘O’ Sit, Balance Fit or Sissel wobble cushions||May 17, 10May ’10||1,100||•••|
|Do you know a good massage therapist in _______? Three quick ways to find decent medical massage or trigger point therapy in your own area||May 1, 10May ’10||800||••|
|Hydrotherapy An introduction to healing with water||Mar 18, 10Mar ’10||800||••|
|Review of Inside Chiropractic: A Patient’s Guide, a book by Samuel Homola An essential guide for anyone who likes a good spine crunch, but is concerned that the chiropractic profession might be imperfect||Jan 2, 10Jan ’10||1,500||•••|
|Body Types and Body Pain Some speculation about what kind of body types might hurt the most, with shameless use of cute dog photos to illustrate||Nov 12, 09Nov ’09||500||••|
|Chronic Low Back Pain Is Not So Chronic The prognosis for chronic low back pain is better than most people realize … especially for Australians in Australia!||Oct 10, 09Oct ’09||600||••|
|Therapeutic Options for Pain Problems A guide to therapies and medical professionals for injuries, chronic pain and other musculoskeletal problems||Sep 28, 09Sep ’09||230||•|
|Three Muscle Knots That Broke The Rules Three examples of myofascial trigger points that responded to therapeutic methods that don’t normally work||Sep 15, 09Sep ’09||700||••|
|Poetry and Reduction in Health Care Both holistic and reductive thinking are both essential components of good health care and science||Aug 23, 09Aug ’09||425||••|
|Battle of the Experts A guide for patients caught between conflicting diagnoses and prescriptions||Jul 6, 09Jul ’09||2,750||•••|
|The Anatomy of Vitality What makes life tick? A poetic romp through the substance of vitality||Jun 27, 09Jun ’09||2,500||•••|
|There Is Only One Health Care Either health is cared for or it is not cared for, whether we call it “alternative” or “mainstream”||Jun 27, 09Jun ’09||900||••|
|Quick-Start Trigger Points Muscle knots that strike with great speed and intensity||Jun 12, 09Jun ’09||450||••|
|Widespread Chronic Pelvic Pain In a Runner With a Surprising Cause Separation of the pubic symphysis (diastasis symphysis pubis), strangely painless at the site||May 9, 09May ’09||550||••|
|Safe athletic training tips Getting into shape without doing damage||Apr 21, 09Apr ’09||600||••|
|Never, Ever Trust “Common Sense”! The fallibility of seemingly sensible ideas about physical therapy||Feb 14, 09Feb ’09||350||••|
|A Recipe for Chronic Neck Pain After Whiplash Science discovers some surprising risk factors for chronic neck pain in the aftermath of whiplash||Jan 20, 09Jan ’09||750||••|
|Into the Fire Trigger point pain as a major injury complication, and how I finally “miraculously” healed from a serious and stubborn shoulder injury by untying the muscle knots||Nov 28, 08Nov ’08||2,400||•••|
|7 Reasons Older Adults Don’t Stay in Exercise Classes And 7 Reasons Why they Should||Nov 12, 08Nov ’08||3,000||••••|
|“But I’ve Already Tried Massage Therapy …” The delicate issue of trying to find skilful treatment for myofascial trigger points (muscle knots)||Sep 23, 08Sep ’08||2,300||•••|
|Measuring Progress in Massage Therapy How do you know whether or not massage therapy is working for you?||Sep 22, 08Sep ’08||1,300||•••|
|Review of The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief, a book by Clair Davies and Amber Davies An important but flawed attempt to spread the word about trigger points||Jul 6, 08Jul ’08||1,000||•••|
|Is There a Difference? “Sex” and knee pain … again||Jun 23, 08Jun ’08||900||••|
|My Very Own Athletic Injuries A journal of my experiences with injuries acquired while running, cycling and hiking and playing ultimate for fifteen years||Mar 30, 08Mar ’08||1,200||•••|
|9 Surprising Ways to Hurt Understanding pain when there is no obvious explanation||Mar 22, 08Mar ’08||1,400||•••|
|Lifting Technique Is Not Important For Your Back A major new analysis of the scientific research supports one of the most unconventional opinions on SaveYourself.ca||Feb 6, 08Feb ’08||600||••|
|Will Therapy Work? The fool’s errand of trying to guess the effectiveness of a therapeutic approach to a pain problem before you’ve tried it||Jan 26, 08Jan ’08||850||••|
|The Gentle Art of Pain Acceptance An important concept in leveraging mind-body connections to deal with chronic pain||Nov 16, 07Nov ’07||750||••|
|No MRI, Please! New medical guidelines “strongly” discourage the use of MRI and X-ray in diagnosing low back pain in the early stages||Oct 8, 07Oct ’07||600||••|
|Trying to squirm your way out of neck or back pain? Consider a little more method in your madness||Aug 17, 07Aug ’07||350||••|
|Three Things That Go Wrong With Muscle Tissue Three of the most common problems that people have with their muscles||Aug 13, 07Aug ’07||600||••|
|A Historical Perspective On Aches and Pains We are living in a “golden age” of musculoskeletal health care … sort of||Aug 6, 07Aug ’07||550||••|
|Give Your Muscles What They Want Resting a “freaked out shoulder” in a sling is actually a fine idea, despite possible medical objections||Jul 15, 07Jul ’07||650||••|
|Iliotibial band syndrome and patellofemoral pain syndrome aren’t as simple as they seem Once again, evidence shows that you can’t blame overuse injuries on seemingly obvious structural problems||May 31, 07May ’07||600||••|
|Apply Occam’s Razor Today! Use a classic logical tool to clean up a mess of confusing theories about your injury or pain problem||May 21, 07May ’07||400||••|
|A delicious cycle How you get better faster the faster you get better||Apr 27, 07Apr ’07||375||••|
|Put your trust in people, not professions Another appeal to choose the therapist, not the therapy||Mar 10, 07Mar ’07||300||••|
|Not Much Of A Connection Many alleged mind-body connections are oversimplified||Mar 8, 07Mar ’07||650||••|
|Endurance Training for Injury Rehabilitation What to do when your usual strength training workout isn’t working … or isn’t an option||Nov 30, 06Nov ’06||1,200||•••|
|PF-ROM Exercises ‘Pain-free range of motion’ or early mobilization exercises can help you heal||Nov 29, 06Nov ’06||1,100||•••|
|Collateral and Re-Injury Prevention Don’t underestimate the importance of prevention … even after you’ve already been injured!||Nov 27, 06Nov ’06||850||••|
|An Open and Closed Case An explanation for a strange duality of muscle sensation observed in massage therapy||Jul 20, 05Jul ’05||2,000||•••|
|A Short Story Slow growth syndrome, oxandrolone and the pathologization of my height||Mar 28, 05Mar ’05||1,900||•••|
|Extraordinary Claims A guide to critical thinking, skepticism and smart reading about health care on the web||Aug 28, 04Aug ’04||2,500||•••|
|Ugly Bags of Mostly Water The chemical composition of human biology||Aug 26, 04Aug ’04||1,500||•••|
|From Atoms to Elvis A wide-angle look at the foundations of biology||Aug 26, 04Aug ’04||500||••|
|An Introduction to Biological Literacy Why you need to know more about your body||Aug 25, 04Aug ’04||1,100||•••|
|Why Massage Makes You Tingle The physiology of sensation in muscle tissue||Jun 26, 04Jun ’04||900||••|
|The Still Life The trouble with a lifestyle of inactivity||Jun 26, 04Jun ’04||650||••|
|Singing, Breath and Scalenes Connections between singing, breathing and a strange group of muscles||Jun 26, 04Jun ’04||1,800||•••|