Is there an echo in here? Didn’t I have another item about this just recently? I did indeed: on July 8 I shared news that glucosamine made no difference for back pain patients, and here we are again with yet another F-grade for glucosamine, this time for knee pain (which is the problem that most people take the stuff for). If glucosamine were a student, its parents would get called in for a conference about little glucosamine’s poor performance. Perhaps there’s something going on at home? This is how the latest report card reads:

Over 2 years, no treatment [neither glucosamine nor chondroitin sulphate] achieved a clinically important difference in [knee] pain or function as compared with placebo.

(The conventional pain-killer celecoxib did not have any effect either.)

The pile of glucosamine failures is now getting rather tall. This morning Dr. Harriet Hall reviewed the evidence of absence of any glucosamine benefits in more detail at ScienceBasedMedicine.org and concludes that glucosamine proponents

… can always complain that maybe it works for knees but not for hips, or that a different dosage might have worked better, or that it works for some small sub-set of patients. There will always be “one more study” to do. … This new study confirms my opinion that we shouldn’t spend any more research dollars doing “one more study” on glucosamine.

Here’s the references for both of glucosamine’s recent epic fails:

• Sawitzke et al. Clinical efficacy and safety of glucosamine, chondroitin sulphate, their combination, celecoxib or placebo taken to treat osteoarthritis of the knee: 2-year results from GAIT. Ann Rheum Dis. 2010.
• Wilkens et al. Effect of Glucosamine on Pain-Related Disability in Patients With Chronic Low Back Pain and Degenerative Lumbar Osteoarthritis: A Randomized Controlled Trial. Journal of the American Medical Association. 2010.

Not that this evidence will actually stop people from “believing” in glucosamine and buying it in bulk! Glucosamine bottlers will really appreciate everyone’s continued gullibility.

My mis-named cat, Cali, investigating SaveYourself.ca central command and thoroughly backlit by three computer displays: a big 27" display, a 24" display, and another 10" of iPad (being used as a display with the help of Air Display). Here’s she looks like when not so silhouetted.

zoom

My short answer is: yes, and I call it “the confidence cure” (see The Mind Game In Low Back Pain). But it’s a deliciously complex subject. Steve Kamper writing for Body in Mind raises a number of good questions:

… just pump up the expectation volume and you get extra bang for your treatment buck. But what if the expectation effect is all you are getting?

A nice little read for therapists.

ADVANCED TUTORIAL

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 198 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! Add it to your shopping cart now ($19.95) or read the first few sections for free!

  $1995

This post from the Department of Almost Meaningless Anecdotal Evidence. Still, dang if stories don’t carry some weight! So, for whatever it’s worth, here are two anecdotes from my own recent experiences with stretching and strengthening. I’ve had plenty of experience with both lately. I have been training hard this season, playing ultimate once or twice a week and hitting the gym almost every day. I’ve got good news and bad news …

The good news (strength)

Progress is possible! I’ve made real progress on strength. I can lift more. Sad to say I can’t really see it in the mirror. But I can definitely lift more. It’s quite satisfying — it feels like it’s been a long time since I made any obvious progress in my fitness level.

“Micro” workouts have been a successful strategy for me, and they go nicely with the concept of “microbreaking.” I often postpone longer workouts and end up not going at all. But if I limit the workout to about 20 minutes, I keep the date. The result is a nice daily rhythm of bite-sized workouts. The best workout is the one you actually do.

The bad news (flexibility)

Despite a consistent and diligent effort, I have not observed even the teensiest improvement in my hamstring flexibility. I’m a bit surprised: despite my general lack of enthusiasm for stretching, I assumed that I would see at least a modest improvement. I’ve given my hamstrings a good hard, long stretch several times per week for several weeks now, at least the equivalent — for my hammies — of taking a regular yoga class.

The lack of progress is so total that I got curious and decided to compare my hamstring extensibility in two strikingly different situations:

• after a long, stagnant session of writing
• in the hot tub after a good soak

I get so stiff when I’m writing that I sometimes actually have trouble walking for about twenty minutes. And yet apparently the feeling of stiffness is not equivalent with a lack of muscle extensibility, because I had no difficulty reaching my toes as normal, even when hobbled like this. I made careful note of exactly how far I could reach — I can just get my wrist to my toes.

After a bit of a reset — I gave the stiffness a good chance to wear off — I went for a nice soak. The hot tub in our building’s excellent spa was particularly hot.

Absolutely no difference. Not one iota more flexible after a hot soak. Toes at the wrist.

Interesting.

Fair to say that’s pretty expectation-defying, even for me. I’m not going to interpret this. I’m just going to report it and let you stretching nuts put it in your collective pipe and smoke it.

For the full scientific report on the value of stretching, see Quite a Stretch: Stretching research clearly shows that a stretching habit isn’t good for warmup, injury prevention, preventing or treating muscle soreness, enhancing athletic performance … or even flexibility!

Makes sense to me.

In case you needed another reason to be skeptical about SSRI anti-depressants, beware that they may make you “five times more likely to swim toward light,” where you may be caught by a bird or a net.