Sadly, as you know, there are no magic bullets. Pain is hard to treat. In fact, there is not a single common painful problem that can be “fixed” reliably by any therapy. And many popular treatments actually fail miserably most of the time, or all of the time. I cannot tell you how often I have heard someone admit that they are still in pain, even though they are spending thousands of dollars on [insert popular therapy].

Despite the disappointing reality, there are many treatment approaches that are still “worth a shot” because they are:

1. safe
2. easy
3. cheap

The less safe, easy and cheap a treatment is, the more scientific evidence is required that it actually works — evidence that is usually lacking for many expensive therapies. (No, science doesn’t have all the answers — but it’s a starting point.) I never recommend anything on this website that is actually disproven or wildly implausible — if you want that kind of advice, there are a lot of other places online that will be happy to give it to you.

However, I do recommend methods that are reasonably harmless to you, your wallet, and your schedule … even if they aren't exactly guaranteed to work. The focus here is on creative and sensible experimentation, on “saving yourself” as long as it’s safe, easy, and/or cheap.

Muscle knots — technically known as myofascial “trigger points” — are a factor in almost all of the world’s aches and pains. A trigger point is a small patch of super-contracted and irritated muscle tissue that can cause symptoms ranging from mild stiffness to extreme pain and a variety of odd side effects. They not only cause pain and problems directly, but also spring to life in response to almost all other painful problems, compounding and complicating them. Even though the existence and importance of trigger points is well known to medical specialists and researchers, most doctors and therapists know surprisingly little or even nothing about them, so misdiagnosis and ineffective treatment are epidemic.

Because of the surprising clinical importance of knots in your muscles, simple self-massage is useful for a surprising number of common pain problems. Even when trigger points are not the cause of your problem, they almost invariably complicate and aggravate the situation, so they are always worth considering even in cases that do not seem especially “knotty.” The main limitation, of course, is your reach! Self-massage is only useful if relevant trigger points can reasonably be reached by your own hands, with tools that you have improvised or purchased for the job, or with the help of a partner or spouse.

Trigger points are right at the heart of my professional expertise, so I have published many relevant articles. If you aren’t familiar with trigger points and how important they can be, please visit Save Yourself from Trigger Points & Myofascial Pain Syndrome! For an in-depth look at how muscles knots work and why they tend to make you feel weak, why they resist stretch, how they can be so stubborn, and why rubbing them probably works, see Dance of the Sarcomeres. For detailed information about self-treating muscle knots, including tips for using tools like tennis balls and massage sticks, see Basic Self-Massage Tips for Myofascial Trigger Points. You may also want to consider picking up a copy of The Trigger Point Therapy Workbook. Another valuable resource is my own “perfect spots” series, which describes several ideal spots in the human body for massage. The series starts with Massage Therapy for Tension Headaches. Speaking of the spots …

The big idea here — what makes this worthy of a tip — is not that there are particularly good spots for massage on the human body, but this: knowing a few of them is almost everything you need to know.

Have you ever heard of the 80-20 rule? This is the “law of the vital few” — in many situations, roughly 80% of the effects come from 20% of the causes. In massage, most of what you need comes from just a few of the most important and satisfying places to massage. Every decent massage therapist has an intuitive grasp of this, and it’s why we are able to seem like we have “magic hands” — it’s actually not that hard to zoom in on the most important spots, because there’s just not that many of them. Of course there are others, and the other 20% do matter. But understanding that a few key points are especially important can really make a difference in your approach … and it’s not nearly as hard to know where to press as you might think.

So start learning your spots!

This is my favourite clever and handy self-treatment tip. It came from combining two other classic tactics for treating your own trigger points: the heat of a bath, with the pressure of a ball (see tennis ball massage). But the result is more than the sum of the parts, and it works better in some ways than any other method of self-massage method I’ve ever come up with. The idea is simply to run a hot bath, and trap a ball between your body and the bottom or back of the tub to rub your back muscles — your buoyancy allows for excellent control with moderate pressures.

And you need the right kind of ball for best results. See The Bath Trick for Trigger Point Release.

A major part of healing is prevention: that is, the prevention of re-injury, and so “prevention” is actually relevant even after you’ve already gotten into trouble. Also, injury and pain problems tend to make people accident prone. When one ankle is sprained, it’s easier to trip and sprain the other one. This is called “collateral injury,” and is amazingly common.

Some collateral injuries are far worse than the original injury. Consider the case of a young woman who tripped and could not catch herself properly because of a shoulder injury, resulting in quite serious damage to her head and face. So, when you are hurting, it pays to make caution and prevention a higher priority than usual. Many of the strategies described below constitute prevention.

See Five Ways To Prevent Sports Injuries and Collateral and Re-Injury Prevention.

Microbreaking is the art of taking small breaks from work and moving around to prevent the many deleterious effects of stillness. In particular, it’s an easy way to keep muscles from developing painful trigger points. It is a survival skill for every chair-bound office worker, student, computer user, or anyone at all whose work (or play) generally requires long hours of being sedentary. But here’s the nugget of the tip: just “taking a break” isn’t enough. Walking to the water cooler and back does not constitute actual stimulation for back muscles that are screaming with stiffness. It is necessary to actually do something therapeutic with microbreaks, and the best choice is usually mobilizations.

For a brief overview of microbreaking alone, see Microbreaking. For a complete survival guide for sedentary work, see Back Pain and Other Hazards of Sitting In Chairs (Way) Too Much.

Endurance training is a weight-lifting workout that uses large numbers of “reps” and lighter loads: i.e. lifting a light barbell thirty times, instead of lifting a heavy barbell eight times. It is a sensible (low risk) default style for most women at the gym. Really, endurance training is just an intense kind of mobilization exercise (see above). Mobilizations are basically just very easy endurance training, and endurance training is just mobilizations with some light weights. It is a terrific way to get some exercise without risking aggravation of myofascial trigger points (muscle knots) — indeed, if done in moderation, without excessively exhausting yourself, it might be a therapy for trigger points. It is almost certainly a more effective self-treatment for muscle stiffness and pain than, say, stretching. I routinely prescribe endurance training exercises to clients who aren’t sure what they should be doing at the gym while injured, if anything.

See Endurance Training for Injury Rehabilitation for more information.

Strength training is the high-load, low-rep load-bearing exercise at the gym that a few guys like to do — and most other people ignore. Please don’t! It can be a valuable component in rehabilitation. Done properly, challenging your muscles is better for general fitness and less time-consuming than you think. It is a terrific way to get fit or stay fit without aggravating existing injuries or risking new ones. Universal gym equipment may be intimidating for beginners, but it offers important rehabilitation advantages: precise, safe control of which tissues you’re affecting. Many people might be much more willing to develop a gym habit if only they understood these benefits.

And yet conventional rehabilitative strength training certainly can be misguided and problematic: overdoing it, sloppy work with free weights, and training problem tissues directly instead of training around them are all risky. In particular, beware of the logic of trying to “strengthen the problem,” like exercising back muscles to treat low back pain: here be dragons!

For a full discussion of the pros, cons, hazards, and best practices, see Strength Training Surprises. To be persuaded that you can get away with surprisingly little time at the gym see, Less is Not Less: Go to the gym much less frequently and still gain strength just as fast (or so close it really doesn’t matter to anyone but bodybuilders).

Stretching without clearer goals than “injury prevention” or “flexibility” is a waste of time that could be better spent on more effective healing strategies. Many recent studies have clearly shown that conventional stretching just isn’t good for much and possibly nothing at all, but people tend to ignore the evidence even when they are aware of it.

To be deprogrammed, see Quite a Stretch

That said, well-planned and specific therapeutic stretching is helpful for some injuries — evidence seems to support the use of stretching for plantar fasciitis, for instance — but I usually do not recommend stretching as self-treatment, because its applications are too few and too specific. The most useful thing you can do with your stretching routine is to stop bothering.

I prefer to prescribe yoga or Pilates (which are much more than just stretching), Mobilize! and Basic Self-Massage Tips for Myofascial Trigger Points See also: Stretching for Trigger Points.

For relaxation and moderate relief from aching muscle pain in a specific location, use heat in the form of heated gel packs, heating pads, Thermophores (a special heating pad), towels saturated in hot water and so on. Full-body heating in hot tubs, showers, saunas and steam rooms is also helpful, especially in conditions where emotional stress and/or knots in your muscles are the cause of your troubles, or a significant complicating factor. See A Better Hot Bath for tips on getting the most out of your bathtub or Jacuzzi. Generally speaking, do not heat recently damaged tissue such as ankle sprains or muscle tears. Both ice and heat may help neck and back pain, but you should usually choose heat: ice is more likely to aggravate cranky muscles, and usually can’t help because inflammation is either not present at all or simply too deep for the ice to affect. See (Almost) Never Use Ice on Low Back Pain! for details.

Please see Using Heat for Pain Problems for more information.

To reduce pain and swelling associated with any acute injury or tendinitis, always use ice (and also elevate the injury above the heart if you can so that it can “drain”). Beware of assuming that neck or back pain are “injuries” that needs icing — they usually aren’t (see (Almost) Never Use Ice on Low Back Pain!). Despite this, both ice and heat will usually help back and neck pain, and you should use whichever seems appealing to you.

Icing may help with tendinitis and other chronic overuse injuries, but not because of any anti-inflammatory effect: tendinitis isn’t an inflammatory condition, believe it or not. Nevertheless, ice may stimulate recovery by other means. For this kind of injury, try “power icing” — 20–50 applications of ice per day for 3–20 days at a time. (Quit early if it’s not helping.) As long as you allow sufficient opportunity for tissue to warm up between applications, this is a safe and easy way to try to stimulate tissues to heal.

Please see Icing for Injuries, Tendinitis and Inflammation for detailed instructions, and some more handy tips, especially how to make a convenient icing tool out of a Styrofoam cup!

Back pain is the number one common pain problem, and an ice pack is the first thing most people will reach for … but it’s usually a mistake. Back pain is rarely an injury — that is, the pain is rarely caused by inflammation which might be helped by ice. Even in cases where inflammation is present, it is usually deep in the back under a thick layer of insulating muscle and the ice cannot “reach” it. However, back pain almost always involves muscular trigger points (muscle knots), which are more likely to be aggravated by ice and helped by heat! For this reason, the majority of people with back pain prefer heat, and a few have negative reactions to ice. For similar reasons, neck pain usually should also not be iced.

Although experiments have shown that both ice and heat are modestly helpful for low back and neck pain, there are good reasons to err on the side of heat. Ice should only be used on the back by patients who clearly prefer it (for whatever reason), or when there is definitely a fresh injury.

Please see (Almost) Never Use Ice on Low Back Pain! for more information.

Contrasting really hits the “safe, easy and cheap” sweet spot. It is a worthwhile self-treatment for a wide variety of conditions that can benefit from an increase in circulation: in other words, practically anything except fresh injuries. Gentle exercise and movement are excellent ways of increasing circulation as well, but it isn’t always an option to exercise a body part enough to increase circulation — contrasting is useful because it is powerfully stimulating to circulation without any significant risk of irritating tissue. (Please note again: it can’t be used on the freshest injuries, because acute inflammation is aggravated by heat.) Similarly, more intense full body contrasting — switching back and forth between hot tub and pool — is an exhausting “thermal workout,” ideal for wearing yourself out and burning some calories without straining anatomy. Contrasting involves alternating between soaking in hot water and soaking in cold. Always finish with cold. Use a double-sink, a pair of buckets, a detachable shower head ... or whatever arrangement you can dream up.

Please see Contrast Hydrotherapy for more information.

It’s a popular idea, but there is no good reason to believe that bathing in dissolved Epsom salts will have the slightest effect on muscle soreness or injury recovery time. Although this folk wisdom may someday prove to have a sound rationale, clearly there is none that its advocates have thought of — or even tried to think of, it seems. Given the low stakes, I think this one is a no-brainer: the smart money is on not bothering.

For (a lot) more detail, see Do Epsom Salts Work?

There is an epidemic of low-grade anxiety out there about whether or not we are drinking enough water, and I believe it’s all unnecessary. Alternative health care professionals constantly recommend this, and seem to assume that throwing back a couple extra litres of water a day is essential to virtually all rehabilitation and general health. But the question would not exist if it weren’t for the scientifically bankrupt work of Dr. Batmanghelidj, who single-handedly invented the “threat” of “chronic dehydration” as a social phenomenon. If the threat exists at all, it is not serious, and easily cured with minimal extra hydration. There are more important things to worry about. Drink when you’re thirsty, or perhaps just slightly more, and ignore anyone who tries to get you too worried that it’s not enough.

For the whole sordid story, see Water Fever and the Fear of Chronic Dehydration.

Sleep deprivation is an unsuspected aggravating factor in a great many cases of chronic pain or slow injury recovery. Indeed, you may be suffering some of the consequences of sleep deprivation even if you think that you are getting a “normal” amount of sleep with 6–7 hours per night. In his book Sleep Thieves, sleep scientist Stanley Coren of the University of British Columbia spells out just exactly how sleep deprived most people in our society probably are, and how much more significant the consequences may be than we realize. An increase in aches and pains, immune system suppression, and weight gain are three common side effects of relatively mild sleep deprivation. And if you are actually suffering from significant insomnia, it gets worse.

Of course, insomnia can be tough to beat, so see Save Yourself from Insomnia! for some of the best sleep repair tips you can find (way beyond warm milk).

Surprisingly, rest is often underestimated or simply ignored as a factor in healing. However logistically awkward and emotionally frustrating proper rest can be, perpetual injury is worse. Particularly for overuse (repetitive strain) injuries, it is necessary to tackle rest like a major tactical challenge, and well-planned rest may be the only rehab strategy that offers any real hope of working. And yet almost no health care professionals or patients take such injuries “seriously” enough to inspire rest that is adequate and well-executed! In such cases, the injury is perpetually and tragically re-aggravated, often by a mis-guided fear that resting the injury will compromise general fitness: but fitness is harder to lose than people think, not such a big deal to rebuild, and in any case the greater evil is remaining injured. Failing to rest can easily lead to many years of chronic pain and reduced fitness. Yikes!

So how do you rest “tactically”? You particularly need relative rest which involves remaining as active as you can — protecting your fitness — while protecting injured tissues as much as possible. Resting sounds simple, but it actually requires quite a lot of planning and savvy to do it properly, and psychological resistance can be fierce. For more of the why and how of resting, see The Art of Rest. For more about the crucial (but sometimes difficult) balance between irritation and stimulation, see The ‘Use It Or Lose It’ Principle.

Obviously good nutrition is generally important to health, but this does not usually require vitamin and mineral supplementation (despite the popular opinion to the contrary, modern food is actually quite nutritious). However, the point of this tip is much more specific: there are some good reasons to believe that even relatively mild nutritional deficiencies may perpetuate or aggravate trigger points and/or other mechanisms of chronic pain, thereby complicating virtually any painful condition. Therefore, a nutritional review is advised when troubleshooting any mysterious or stubborn pain problem, and moderate supplementation might make a difference.

Detailed information about it is available only in a chapter by Dr. Tim Taylor in our book, Save Yourself from Trigger Points & Myofascial Pain Syndrome! Vitamin D stands out, and is covered in the next tip.

For chronic pain patients specifically — not just anyone, but people with a genuine chronic pain to solve — vitamin D has real promise. There is still no proof yet that D deficiency can cause pain, or that D supplementation can treat pain, but there is more than enough indirect evidence connecting them to be of interest, and it is quite cheap and safe to take vitamin D, even a fair bit of it. There’s quite a lot of safety “wiggle room,” and the maximum dosage commonly available over-the-counter in North America (5000 IU capsules of vitamin D3) is well within the safe range.

Naturally, you should run this by your doctor, who may have fair concerns: in 2010, the US Institute of Medicine published new guidelines for dosages of Vitamin D which seem to discourage higher dosages. However, those guidelines are really aimed at the “worried well,” and not pain patients. Here’s my own readable summary of dosing safety information, and here’s some heavier reading (but still good). D supplementation is also covered in full detail by Dr. Tim Taylor, co-author of my muscle pain tutorial.

Does “quit smoking” seem a bit boring for a pain-busting tip? I don’t think so. It’s incredible how toxic smoking is: it affects everything. “Smoking was established long ago as a strong predictor of failure of pain treatment,” writes Dr. Tim Taylor, a chronic pain specialist. “Smokers are so difficult to treat that I will not accept smokers as patients.”

Therapists and patients often miss the forest for the trees. This is yet another example how the obsession with finding specific, “exciting” and therapizable biomechanical causes of pain (structuralism) can distract from simpler, more fundamental, and more powerful explanations. Smoking is one of those rather general factors — like insomnia, or nutritional deficiencies — that might just be the biggest reason an otherwise minor pain problem is being so stubborn.

Smokers often believe that they’re mostly just hurting their lungs, but that’s just the tip of the iceberg. There really is hardly a single aspect of your physiology that isn’t taking a hit. Smokers are compromising so many aspects of their health that quitting is a vital pre-requisite for beating pain.

If you smoke and you hurt, you need to quit.

See also: Insomnia Until it Hurts

There are several popular “nutritional” supplements other than vitamins and minerals that people take because they are supposed to be “good for” your muscles and joints. They aren’t considered pain-killers, but people take them for pain. They aren’t anti-inflammatories, per se, but people believe they will reduce inflammation. They aren’t performance-enhancing “drugs”, but athletes and bodybuilders take them like almost like drugs to enhance their performance. Every one of them suffers from a lack of good evidence of efficacy, and not for lack of trying in the case of the popular ones. Not one of them is a clear winner. Not one is definitely helpful. There’s a lot of seemingly conflicting evidence about nutraceuticals. However, there’s a pattern of much ado about nothing. Even the most generous interpretations of the most positive-seeming results are still kind of underwhelming — and that’s the best you can say about them.

The evidence strongly suggests that posture is not terribly important as a factor in any serious chronic pain problem. Poor posture and structural problems like scoliosis (spinal curvature) definitely do not necessarily cause pain. Meanwhile, plenty of people with acceptable posture have terrible pain problems. So something isn’t adding up there! Postural correction is also so challenging that it is probably rarely worth the trouble — I’ve never seen a single clear case of improved posture. Nevertheless, I have never been able to dismiss the importance of it entirely, and there are some examples of specific postural habits with unfortunate consequences. Poor posture has got to be at least a contributing factor in some problems. Probably the most effective approach is simply to increase levels of complex physical activity in your life. Literally “taping” your body into place — applying tape in a way that restricts your motion to the desired range — is probably a fairly effective shortcut, but still tricky and unpleasant.

For reviews of strategies, see Posture Exercises for Posture Correction. For more in-depth examination of the subject, see Stand Up Straight.

There’s poor posture and then there’s postural strain — circumstances that make it difficult to maintain a posture. People often face strain due to poor ergonomics: poorly designed and inherently awkward work. Ergonomic fine-tuning of your workstation and life is usually much less important than being generally active, and taking regular breaks from whatever you do, however you do it. However, there are some common ergonomic problems out there that certainly need correcting, and it’s well worth looking for the ergonomic “low-hanging fruit.” The problems I’ve encountered the most often are: high monitors and holding the phone to the ear which tends to cause headaches and neck cricks, and reaching high and far for keyboards and mice which often results in elbow and wrist pain. And don’t forget that microbreaking is a really great strategy for reducing strain, and it’s especially important when you can’t actually eliminate the strain.

For other ideas, see Unconventional Ergonomics and Back Pain and Other Hazards of Sitting In Chairs (Way) Too Much.

Sitting on a wobble cushion is like sitting on an exercise ball — it gives your postural musculature something to do, keeps your back and core musculature “frisky” — only more practical and convenient. Sitting on exercise balls is a great idea, but they are bulky, you can’t sit on them all the time, and there is rarely room in anyone’s office for both a chair and an exercise ball. Enter the Disc ‘O’ Sit, Sissel Balance Fit, or Sissel Sit: compact enough to be convenient, wobbly enough to be therapeutic. This isn’t going to cure anything, but postural stagnancy and strain from sitting is such a loud “background noise” for so many people, and this is such a reasonable and plausible partial antidote, that it earns itself a section on this page.

See Wobble Cushion Technique for more.

Should you buy an expensive chair? Probably. Good chairs aren’t everything, but they do help. The best in my opinion is the Herman Miller “Aeron” ergonomic chair. (They do not pay me — I’ve just got one.) It’s like this: sitting on anything for ten hours is probably a more important factor in your health than what you are sitting on, but if you plan on logging about 40,000 hours in a chair over the next twenty years, you might as well make it a good one. My advice is to splurge a little and buy an Aeron for your office — at home or otherwise — and buy it now, not after another 6,000 hours of sitting have gone by. Unlike any other chair I know of, they come in three sizes. They are extremely well-designed and highly adjustable. They have a many-year warranty, and are built in such a way that they will probably last much longer. And they are not that expensive, especially when you consider how long they last. End of sermon.

See HermanMiller.com. For other chair warrior survival tips, see Back Pain and Other Hazards of Sitting In Chairs (Way) Too Much.

First of all, stop worrying about cracking your joints: there is no compelling evidence that there is any significant risk in doing so. Second of all, if it’s appealing, make a point of cracking your spinal joints in moderation in order to facilitate recovery from pain and stiffness in the torso and neck. The chiropractic profession would have us believe that joint cracking is essential to general health, which goes way too far. However, but scientific evidence has shown that it probably is at least a little bit helpful to stimulate joints with cracking and other “adjustment.” Obviously, please don’t crack your joints if you hate the feeling. But if it feels relieving, by all means, go for it, without guilt or concern, in reasonable doses: like many physical therapies, it supplies a blast of fresh sensory input which probably has a cascade of minor benefits.

I offer an incredibly detailed analysis of the science of spinal manipulative therapy to customers who purchase either my neck pain or back pain tutorials. Some simpler related information is available to all in my article Does Chiropractic Work?

“Pain is an opinion on the organism’s state of health.”

Ramachandran et al, Phantoms in the Brain: Probing the Mysteries of the Human Mind, 1998

Those may be some of the most important words ever written about chronic pain. A truly good understanding of them may actually treat pain. “Ramachandran” is not an eastern mystic, but a neurologist. His important idea — supported by a great deal more research ever since — is that the experience of pain is powerfully affected by our level of anxiety. Not only do the body’s nerves send messages about problems to the brain, but the brain tells the nerves how sensitive to be. Thus, we invariably hurt more when we are worried, and less when we are calm.

This principle is of critical importance to pain management and recovery, and indicates a rational, urgent need for self-education (the most important part of) anxiety-reduction to be a part of every difficult healing process. This is the main reason that I publish a website called “save yourself,” with a focus on education and deep learning about the nature of pain problems. Self-education is hardly guaranteed to work, but it is definitely safe, “easy” in some ways, and nearly free (compared to therapy) — and it has a number of other benefits, chief of which is that having a better understanding of how pain works is really helpful in knowing how to avoid many therapies that are expensive, pointless and potentially harmful.

Continue reading on this topic with Pain is an Opinion. For some ideas about managing anxiety, see Help for Anxiety.

Orthotics can be a good-bang-for-buck solution to a variety of otherwise untreatable postural problems and gait dysfunctions. On the one hand, I cannot emphasize strongly enough that things like leg length differences are much less important than physical therapists generally make them out to be. However, they can be a factor, and sometimes the stars line up and orthotics make a clear positive difference. Better still, research has shown that expensive orthotics are often no better than cheap generic ones.

There is one problem, though: sometimes they backfire, probably because they can be difficult to adjust to, disrupting fine-tuned postural adaptations and forcing awkward new ones. Some people find the cure to be worse than the disease.

If you do need customized orthoses for whatever reason, go with a reputable supplier, and certified pedorthists are by far the best choice. You should be quite cautious about purchasing orthotics from physiotherapists, chiropractors, and even podiatrists. For more information, see The Trouble with Orthotics.

As science advances and mind-body perspectives on health and healing become more sophisticated and practical, we understand that pain problems are powerfully mediated by stress, self-limiting behaviours, and “emotional constipation.” Professionally, I have been in an ideal position to see how people’s quirks and habits cause, slow, and prevent all kinds of healing. Particularly for people struggling with a difficult healing process, I recommend “getting personal.” Sometimes it’s a matter of just learning new coping skills for a problem that is never going away. And sometimes people need to come to terms with the fact that years of self-sacrificial workaholism, for example, are actually the root cause of severe chronic pain. Usually the truth is in the middle: healing requires a complex mix of coping skills and personal responsibility. Through this kind of learning, people often find long term relief.

Of course, there are nearly infinite ways of approaching this challenge, and I’ve written about it in several ways. I discuss the theory in detail in Why Do We Get Sick?, and I get more thoroughly practical in The art of healing by growing up. Pain is an Opinion covers some “mind over matter” concepts in great detail. You might also want to read Dr. Gabor Maté’s excellent book When the Body Says No. Or go straight to HavenHaven. There is also one extremely useful personal growth tool that you can start leveraging right away: see the next tip.

This is the most unusual self-therapy suggested here. Despite my slow but steady evolution from New Age flake to a man of science over the years, I remain convinced that this is a fascinating and useful approach to rehabiliation. Basically, it involves breathing quite quickly and deeply for up to a quarter hour, without controlling or “shaping” the movement of breath. This breathing pattern is strongly stimulating and can dramatically change your overall state. It is a “pattern buster” that interferes with habitual ways of holding your body and limiting self-expression, a vital personal growth and transformation tool.

See The Art of Bioenergetic Breathing for more information.

The evidence is overwhelming: moderate exercise is not just fantastic for your body and long term health, but your brain as well. Although relief from specific anatomical stresses can be critical, overall rest is sometimes the last thing patients need. A sedentary lifestyle is a major aggravating factor in many injuries and pain problems, and particularly problems caused or complicated by myofascial pain syndrome (muscle knots). A lack of exercise or variety of activity generally impairs circulation and the vitality that is needed for healing, but it also constitutes an irritant in itself: sitting is stressful for many tissues, for instance. An increase in activity could be an important pre-requisite and support system for healing.

Training regimens and/or exercise classes are appropriate for athletes and the athletic, but if you are bit of a couch potato, those are probably the last things you want to do, and they’re doomed to failure. What, then? Basics: start walking or cycling to work, take the stairs instead of the elevator, take the batteries out of the remote, etc …

See The Still Life and/or Back Pain and Other Hazards of Sitting In Chairs (Way) Too Much for more. And keep in mind that it is easier to build strength than you think.

I have a particularly wise tip on the subject of stress relief, which I am proud of. No doubt about it: psychological stress aggravates pain, and it’s well worth reducing stress if you possibly can. The problem is that it’s so much easier said than done. Most pain patients scoff at advice to relief stress — it seems impossible, especially when you’re in pain. So what to do?

Try fast deep breathing instead of slow! Slow breathing and chill out time can come later, after you’ve blown off some steam. When people think of “taking a deep breath” to relax, they usually think of a slow breath. I don’t know about you, but the last thing I want to do when I am really stressed out is slow down and take a really deep, slow breath: I want to scream and huff and puff and run around in little circles! So I do!

Stress is expressed in the body in amazingly strong habitual muscular tension and breathing patterns (among other things). One of the quickest and easiest ways of de-stressing is simply to mess with those patterns: to more literally “blow off steam” with vigorous breathing exercises, and with movement, dancing, shaking, and vibration. This gets to the heart of the matter much more directly than any relaxation exercise, and provides more opportunity than athletic exertion to work with under-expressed and repressed feelings of anger, sadness, frustration, and anxiety.

For more about blowing off stream with breathing, see The Art of Bioenergetic Breathing. For more about vibration therapy, see Good Vibrations for Stress and Tension.

Sometimes the goal of healing is to get to a point where you can actually think about doing a yoga class — and sometimes a yoga class is how you heal. There are many circumstances where I prescribe exercise classes to a client, usually yoga, and sometimes Pilates, taiqi, aerobics, or cross-training classes like the currently popular “boot camp” classes. Of course, nearly any kind of exercise, even a sport, can become a useful part of a rehabilitation program, but I have a specific reason for singling out exercise classes, especially yoga: for non-athletes who might not otherwise be interested, there is simply no better way to explore of body awareness and safely test your limits with a variety of new challenges. Also, I believe that a social environment is helpful to most healing processes: seriously, injury loves company!

And yoga is not for everyone. The reputation and popularity of yoga and meditation is immense, almost oppressive, sometimes eclipsing other options. People feel that they “should” try them in order to reduce stress and contribute to a healing process. They often feel guilty for not trying them or for not liking them. If this is you, please read The Tyranny of Yoga and Meditation!

People (especially older people) often fail to make a habit of exercise classes. For some tips, and a bunch of inspiring scientific evidence about the importance, see 7 Reasons Older Adults Don’t Stay in Exercise Classes.

Progressive training is a (really) basic concept in athletics and injury rehabilitation — so basic that it seems almost unnecessary to spell it out, and yet I routinely see people failing to respect the principle of “baby steps”! The idea is to break challenges up into small intermediate goals. All serious athletes train progressively, because it’s the only way to get the job done. It is the basis of every running group. Runners who patiently increase the length and intensity of their runs are training progressively, and are at much lower risk of injury. The principle is the same whether you are fit and working towards an athletic goal, or injured and simply trying to get back to normal.

For more information, see Progressive Training.

Friction is a specific self-massage technique applicable only to cases of tendinitis. It is a method of stimulating tissue when normal use of the tendon will only irritate. Rub back and forth across the most painful spot on the tendon for five minutes, increasing the intensity whenever the sensation fades. If it doesn’t fade, stop.

For more details, see Friction Massage Therapy for Tendonitis.

“Early mobilization” is an important concept in rehabilitation that only dates back to about the 60s — prior to that it was in vogue to immobilize injured patients for long periods — and has since been proven to speed healing from traumatic injuries. Even when an injury is acute (fresh), it is important to use whatever pain-free range-of-motion (PF-ROM) you have got. It stimulates circulation, metabolic activity, and normal neurological function. At the same time, of course, you have to be cautious not to irritate the injury — that’s why it’s pain free. Chronic and non-traumatic injuries and dysfunction may also benefit from more thorough mobilization, although the approach is a little different.

For more detailed information, see PF-ROM Exercises. To learn more about striking the right balance between rest and movement, see The ‘Use It Or Lose It’ Principle.

“Mobilizations” are rhythmic, repeated movements that alternately stretch and contract musculature and other soft tissue — massaging your tissues with movement. I prescribe at least one or two key mobilizations to nearly every client, usually in preference to stretching. Mobilizations are more “neurologically interesting” than stretching and stimulate more metabolic activity in the tissue while remaining gentle. They are more practical and efficient than stretching in many ways, especially because they can affect more tissues more quickly, and because they constitute both a better warm up and a better warm down for more intense activity.

See Mobilize! for more information.

Hip weakness or “dead butt syndrome” has become the most popular new scapegoat for some very common athletic overuse injuries, especially running injuries, like iliotibial band syndrome, patellofemoral syndrome, shin splints, and Save Yourself from Plantar Fasciitis!. It’s being blamed so often, by so many people, for so many common pain positions, that warning people about it seems worthy of this list. Simply put, the evidence is not in — and, indeed, what little evidence there is has been blown way out of proportion. If you want stronger hips just for the sake of stronger hips, knock yourself out: just keep your expectations low. No way is it a magic bullet. It sounds too good to be true, and it is.

It’s a complex subject, but that’s what this website is all about! You can read all about it, in excruciating detail: Does Hip Strengthening Work for IT Band Syndrome?.

ZOOM

Irony, Man

In a dazzling display of irony, the September, 2009, issue of Runner’s World both quotes me as an expert debunking conventional wisdom about stretching, and yet uncritically promotes a new myth for a new generation of runners: the hip-strengthening myth.

ZOOM

Irony, Man

In a dazzling display of irony, the September, 2009, issue of Runner’s World both quotes me as an expert debunking conventional wisdom about stretching, and yet uncritically promotes a new myth for a new generation of runners: the hip-strengthening myth.

ZOOM

Voltaren Gel

Not exactly a magic bullet, but probably safe, reasonable, and worth a shot.

Made available in North American only recently, Voltaren® Gel is a particularly safe and useful medicine that few people on this continent have heard about yet. Think of it as ibuprofen in a gel. 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. 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.” This product actually works and gets a pass from skeptics and critics — a rare thing in the world of pain treatments.

For more information, see Voltaren® Gel: A promising rub-on anti-inflammatory medication.

One of the most popular pain-relief products of any kind, Traumeel, is a homeopathic remedy, not an herbal or “natural” remedy as most people assume. Homeopathic remedies are extremely diluted by definition, so the actual amount of herb in a tube of Traumeel is mind-bogglingly small. If it worked, it would be easy to prove — but it never has been proven by the standards we expect of other medications. Homeopaths say that science can’t test the effectiveness of homeopathy because it’s beyond our understanding, but that’s not true: you can always test if something works, even when don’t know how it works.

If Traumeel is in your medicine cabinet, you should reconsider whether or not it belongs there. For more information, see Does Traumeel Work? A detailed review of Traumeel® and other homeopathic/herbal arnica creams used for muscular pain, joint pain, sports injuries, bruising, and post-surgical inflammation.

Minor update (Aug 26 '11, section #22) — New graphics and a quote from Dr. Tim Taylor. See section #22, Quit smoking: it’s not just for your lungs.

Upgraded (Jun 3 '11, section #19) — Added important phrasing about prioritizing rest of worries about maintaining fitness. See section #19, Tactical resting: the underestimated art of taking it easy.

New section (May 19 '11, section #21) — After studying and reviewing the science and safety of Vitamin D supplementation, I’m finally ready to start recommending it to my readers. See section #21, Vitamin D: the most likely of all supplements to be useful for pain.

New section (May 4 '11, section #42) — No notes. Just a new section. See section #42, Reconsider Traumeel: the most popular of all “herbal” pain creams has very little herb in it.

New section (May 4 '11, section #41) — No notes. Just a new section. See section #41, Try Voltaren: anti-inflammatory medication only where you need it.

Rewritten (May 4 '11, section #19) — Total revision to strongly emphasize the stakes and the key idea that resting actually requires a lot of good planning. See section #19, Tactical resting: the underestimated art of taking it easy.

Updated (May 4 '11, section #15) — Added the concept of a “thermal workout.” See section #15, Contrasting with heating and cooling: well worth a shot.

Rewritten (May 4 '11, section #10) — Completely revised to emphasize the best and least advertised benefits of strength training. See section #10, Strength training: better, easier than you thought.

New section (Apr 28 '11, section #40) — “Weak hips” is a weak theory! But the hype grows and grows, and must be stopped. See section #40, Don’t bother with hip strengthening: “weak hips” is a poor scapegoat for chronic leg injuries.

Updated (Apr 28 '11, section #35) — Added an important link. See section #35, Exercise classes: aerobics, yoga, Pilates, tai chi, boot camp, etc ….

New section (Apr 28 '11, section #22) — Does “stop smoking” seem like a boring tip? It’s not … See section #22, Quit smoking: it’s not just for your lungs.

Revised (Apr 28 '11, section #13) — The idea of “perfect spots” is worthy of its own tip. Read to find out why. See section #13, Raw icing and power icing: for acute and chronic injuries.

New section (Apr 28 '11, section #5) — The idea of “perfect spots” is worthy of its own tip. Read to find out why. See section #5, Learn your perfect spots for pressure: a few key points go a long way.

Major update (Apr 28 '11, section #5) — Several minor repairs, two new tips, and a re-write of the icing section. See section #5, Learn your perfect spots for pressure: a few key points go a long way.

Major update (Apr 27 '11, section #5) — Complete re-write! So thoroughly upgraded it’s like a new article. Modernization of all tips, purging of some that were too old school, and several new ones. This is now a main site page and all future updates will be logged. Several more improvements on the way. See section #5, Learn your perfect spots for pressure: a few key points go a long way.