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If any treatment worked really well for any painful problem, it would be the only one to discuss. There wouldn’t be a plethora of treatments to consider. There wouldn’t be a bunch of imperfect options for me to review in my books. Which is why Chekhov wrote this:
Like most writers, I collect quotes that add colour, gravitas, or support to my own writing, and there are dozens of them around SaveYourself.ca. So, how could I have never noticed this quotation before? Funny how even the apt-est can escape a writer’s attention for years at a time!
When a lot of remedies are suggested for a disease, that means it can’t be cured.
Anton Chekhov, The Cherry Orchard
A new blurb on the weirdness of pain, from a coming-soon update to the patellofemoral pain syndrome book (and equally applicable to most chronic pain problems).
What if the red warning light on the dashboard was wrong? What if the alarm system itself was malfunctioning? What if there wasn’t much going on in your knees at all anymore, but your brain kept flashing that warning light?
This happens. The brain has immense power to tune pain severity and quality, independently of whatever’s actually going on in your knees. Fear, anxiety, and stress dial pain up. No one is surprised to hear this, but almost everyone underestimates it.
In related news, I rebranded my main pain article yet again, and I think I’ve settled on a good title for the long haul: Pain is Weird.
This is an extremely popular warm-up ritual, performed with great faith by millions of people, that not only doesn’t help but actually dings performance. That’s an impressive disconnect between belief and reality.
My huge stretching article has been duly updated.
Watch this Japanese advertisement for a core strength training machine. It just keeps getting better!
Oh, and: earworm warning.
Dry needling is not convincingly superior to sham/control conditions and possibly worse than comparative interventions…
I have written a lot about about how surprisingly little connection there is between pain and obvious-seeming causes like poor alignment, or even vivid arthritic degeneration. And what is true of humans is apparently true of our pets as well. Veterinarian Johnny Bat-Yonatan on canine hip dysplasia, an arthritic condition common in big breeds like Labrador retrievers, German shepherds, and rottweilers:
It’s a horrendous thing that often leads to the animal having to be euthanised, but the highly specialised grading of hip dysplasia doesn’t correlate directly with mobility and life quality. You have great x-rays of animals that can barely walk, and horrendous hips in dogs that don’t display any pain. X-rays sometimes tell a story, other times they’re a footnote. We learn early that we need to treat the animal, not the radiograph.
“Treat the animal, not the radiograph.” Nicely put, and equally apt for pets and their humans. We’re all animals! For more information, see Canine Hip Dysplasia, by Wendy Brooks, DVM, DipABVP.
Grant, Tjoumakaris, Maltenfort, and Freedman in the American Journal of Sports Medicine:
The emphasis on increasing levels of evidence to guide treatment decisions for sports medicine patients may be taking effect.
Fantastic news, if true. On the other hand, maybe I should be careful what I wish for: my entire career is based on making some sense out of the hopeless mess that is sports and musculoskeletal medicine…
“Levels of Evidence in the Clinical Sports Medicine Literature: Are We Getting Better Over Time?”
A few years ago I published an article about the over-hyped importance of fascia, the sheets of connective tissue that bind us together. It covers several popular, dubious theories about why massage therapists and other manual therapists should try to manipulate fascia specifically. I’ve updated the article several times, but recently it struck me that I had strangely neglected something basic:
What is the actual clinical significance of fascia in medicine? Why would it come up for a family doctor? Why would a surgeon think about fascia?
The answer is boring but critical: fascia functions as an important infection barrier. Much like skin prevents pathogens from getting into the bottom in the first place, layers of fascia limit their spread. For example, from Gray’s Anatomy for Students:
A typical example of a fascial layer would be that overlying the psoas muscle. Infection within an intervertebral body secondary to tuberculosis can pass laterally into the psoas muscle. Pus fills the psoas muscle but is limited from further spread by the psoas fascia, which surrounds the muscle and extends inferiorly into the groin pointing below the inguinal ligament.
But there’s a dark side to this vital function — one of the most unpleasant malfunctions in medicine. If fascia stops the spread of disease, what happens behind the barrier? Well, it can get grim: a blocked infection is also a trapped infection, and if it burns out of control it can destroy the contents of the compartment. Journalist Miles O’Brien lost a forearm to compartment syndrome, a raging infection that came out of nowhere and inflated his forearm like a high-pressure sausage.Journalist Miles O’Brien lost a forearm to compartment syndrome — see “Just a Flesh Wound” — a raging infection that came out of nowhere and inflated his forearm like a high-pressure sausage.5 Since fascia is so tough and will not yield, circulation gets cut off and all the flesh in the compartment begins to die. The compartment must be sliced wide open to bleed off the pressure — a huge, grisly wound and a slow, difficult recovery even if all goes well. And it didn’t all go well for O’Brien:
Things tanked even further once I was on the table. And when I lost blood pressure during the surgery due to the complications of compartment syndrome, the doctor made a real-time call and amputated my arm just above the elbow. He later told me it all boiled down to a choice…between a life and a limb.
“Just a Flesh Wound”, O'Brien (milesobrien.com)
Now that is clinical relevance. That’s how the properties of fascia medically matter — its toughness as a wrapping, primarily.
Audio articles are exclusively available as a perk for my boxed set customers (plus any visually impaired reader). I also extended the one about my trigger point doubts, keeping up with major recent updates to the written version.