SaveYourself.ca • Sensible advice for aches, pains & injuries
 

Reading Guide for Professionals

What’s on SaveYourself.ca for therapists and doctors?

This website is for both patients and health professionals. It is always addressed to patients — but professionals appreciate clear, readable, jargon-free information just as much as patients do. Key features here for professionals:

Doctors too? Yes, doctors read this website. Over the years, many physicians have given me a thumbs up for my science-based approach to the subject matter, and they often write with helpful corrections as well. One of my co-authors, Dr. Tim Taylor, is a physician and pain specialist. I also correspond constantly with several of the physicians at ScienceBasedMedicine.org (and that’s quite educational, I can tell you).

What’s here? Explained with jargon

SaveYourself.ca is primarily about conservative manual and physical therapies for muscle pain, low back and neck pain, and repetitive strain injuries, especially in the lower leg. There is a focus on the importance of neurobiological mechanisms of pain, such as like central sensitization, and I constantly chip away at the therapeutic dinosaur of the postural-structural-biomechanical model of pain.

I get deep into plausibility and evidence for etiologies and treatments, clinical reasoning, and diagnostic logic. I avoid trying to produce detailed reference information: there are excellent texts for that. So, for instance, I do not systematically describe special orthopedic testing for any condition or provide detailed differential diagnosis charts, but I will translate and explain the implications of a scientific paper about the reliability of a test.

Despite the surprising scope of this one-man show, it’s not a medical publishing empire (yet). My own training and expertise is limited,3 and I am careful to respect my own limits. I particularly avoid pathology-driven pain problems and invasive treatment methods.

Musculoskeletal and rehab science geekery

Patients find it difficult to find good help for many kinds of chronic pain problems. Diagnostic wild goose chases are common. The majority of pain problems slip into a gigantic crack between hospital orthopedics and rheumatology. For everything else, we simply don’t much about know why people hurt, and keep hurting. Often we can offer our patients no better than educated guesses. And there is controversy about virtually every kind of thinking and therapy.

SaveYourself.ca tries to make sense of it all. Everything written here was written for love of the topic — I am a musculoskeletal science geek.

Some of my favourite sources

I spend a lot of time on PubMed, and I cite from the best sources whenever possible, like The Cochrane Collaboration and The New England Journal of Medicine and PLoS Medicine.

Some of my favourite sources

I spend a lot of time on PubMed, and I cite from the best sources whenever possible, like The Cochrane Collaboration and The New England Journal of Medicine and PLoS Medicine.

Just who do I think I am?

Please accept my apologies for all the criticism. I often criticize practices that cannot be supported by science. What gives? And who do I think I am? “It seems a poor way to run a business,” commented one irritated massage therapist. “Do you really think it’s smart to criticize your potential customers?” I think it’s smart to be true to my nature, attracting and earning the trust of the readers I respect — the critical thinkers. We can get nowhere in health care without healthy, vigorous debate.

Not everyone in medicine can be constantly making calculations about the value of the information. You’d go crazy. But if you are in a subspeciality field … you not only need to know what people know but how they know it. You have to regularly question everything and everyone.

James Lock, MD, Chairman, Dept of Cardiology, Boston Children’s Hospital

My own top picks for professional readers

  1. SY Your Back Is Not “Out” and Your Leg Length is Fine — The story of the obsession with crookedness in physical therapy and treatment for chronic pain. This article challenges the clinical paradigm that has dominated manual therapy for decades. If you only read one article on this website, please read this one.
  2. SY Pain is an Opinion — What recent pain science can do for your chronic pain right now. Although quite basic and not quite yet what it should be, most clinicians are not aware of most of this information and really, really should be.
  3. SY 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.
  4. SY Does Fascia Matter? — A detailed critical analysis of the clinical relevance of fascia science and fascia properties. Fascia is hot hot hot right now, but despite all the conferences and fascia-fanaticism it’s just not clear that fascia matters. Find out exactly why.
  5. SY The “Impress Me” Test — Most controversial therapies are fighting over scraps of scientific evidence. A short, sweet article about a simple idea that really simplifies a lot of debates about “what works.”
  6. SY Does Arnica Cream Work for Pain? — A detailed review of popular homeopathic (diluted) herbal creams like Traumeel, used for muscle pain, joint pain, sports injuries, bruising, and post-surgical inflammation. Because Traumeel is homeopathic and therefore a contentious topic, I’ve probably never worked harder to dot my i’s and cross my t’s. This is a really painstakingly constructed analysis. It took weeks of work to produce, and it’s completely free. It’s also one of the most popular articles on the website, second only to the one about Epsom salts.
  7. SY Quite a Stretch — Stretching research clearly shows that a stretching habit isn’t good for much of anything that people think it is This is SaveYourself.ca’s original “controversial” article. Stretching was the one of the issues that got me writing. Chock full of myths … myths that you may still be passing on to your patients.
  8. SY Ioannidis: Making Medical Science Look Bad Since 2005 — A famous and excellent scientific paper … with a dangerously misleading title. This is probably one of the geekiest articles on the site, as well as one of my favourites.

To find other reading suitable for professionals, visit the main table of contents page and look for articles marked with this symbol:

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Notes

  1. Grundy et al. Does unequal leg length cause back pain? A case-control study. Lancet. 1984. PubMed #6146810.

    This classic, elegant experiment found no connection between leg length and back pain. Like most of the really good science experiments, it has that MythBusters attitude: “why don’t we just check that assumption?” Researchers measured leg lengths, looking for differences in “lower limb length and other disproportion at or around the sacroiliac joints” and found no association with low back pain. “Chronic back pain is thus unlikely to be part of the short-leg syndrome.” Other studies since have backed this up, but this simple old paper remains a favourite.

    So what’s special about this footnote? You don’t have to take my word that the source is relevant — readers can easily link to the original source material, and check the relevance and quality of the reference. The presentation is attractive and useable. Under the hood, custom tech makes it a snap for me to publish richly cross-referenced, “interactive” bibliographic data — better technology and higher standards for publication than most scientific journals.

    BACK TO TEXT
  2. Obviously it’s not PubMed or even PEDro (the Physiotherapy Evidence Database) — it’s not an institutionally run and funded database. However, what it lacks in sheer size it more than makes up for with charm, personality and focus. As far as I know, the SaveYourself.ca bibliography is the single largest resource of its kind, consisting of well almost 2000 entries, mostly from mainstream medical journals. And it’s not just a list — it’s a readable, annotated bibliography. Quickly get the gist of a paper, my take on its significance, and anything else that’s noteworthy and interesting. Much better than just reading abstracts! BACK TO TEXT
  3. Massage therapists in my part of the world are surprisingly well-trained — three years — but that is, of course, still less than physical therapists and chiropractors, who in turn study much less than any physician. See more information about my credentials. BACK TO TEXT