SaveYourself.ca helps you solve pain problems

published May 1, 2009, updated 6/16/10

SaveYourself.ca Reading Guide for Skeptics

A tour of SaveYourself.ca features and resources for readers who doubt the efficacy of many popular treatments in alternative health care, especially manual therapies like chiropractic and massage therapy

by Paul Ingraham, Vancouver, Canada MORE
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Credentials and qualifications

I am a writer and retired Registered Massage Therapist (unusually well-trained for a massage therapist, a 3000-hour program). I’m almost done with a Bachelor of Health Sciences degree. I am a peer reviewer for The Natural Standard, and a copyeditor for Science-Based Medicine. My most important qualification is more than a decade of workaholic post-graduate study, clinical experience, and constant conversations with readers from around the world, including many experts who have provided countless suggestions and criticisms.

For more information, see: Who Am I to Say? More information about my qualifications, credentials and professional experiences for my readers and customers.


This document introduces SaveYourself.ca to my favourite audience: skeptics. Skeptics should feel at home on this website. I am a card-carrying skeptic myself, literally — I am member of the James Randi Educational Foundation,1 and I have a card! Last year I attended (and wrote about) my first Amaz!ng Meeting — the world’s largest critical thinking conference. I also attended the science-based medicine conference that preceded it, and was honoured and greatly educated by several conversations with physicians like Dr. Steven Novella. Those converesations led to me being a regular volunteer copyeditor for Science-Based Medicine.2 I even know Simon Singh just a little bit.3

What is a skeptic? Who is this page for?

Not sure who this page is for? Being a “skeptic” used to mean that you were an middle-aged curmudgeon ranting about bogus UFO photos to whoever would listen in a gloomy corner of some pub. Today, some skeptics look like this:

Rebecca Watson, celebrity skeptic, of <a href="http://skepchick.org/blog/">Skepchick.org</a>. Hot picture used with Rebecca’s permission for this. And congratulations on your wedding, Rebecca!

Rebecca Watson, celebrity skeptic, of Skepchick.org. Hot picture used with Rebecca’s permission for this. And congratulations on your wedding, Rebecca!


In the last 10–20 years, “skepticism” has become a broad social movement promoting science and reason in every walk of life. We have conventions, societies, blogs and really good parties. No skeptic pride parades yet, but I’m sure it’s just a matter of time.

But you’re a massage therapist! Aren’t scientifically questionable claims common in massage therapy?

(I was a massage therapist. I’m not any more.4But regardless … ) According to Dr. Stephen Barrett of QuackWatch:

Ordinary massage and the legitimate practice of massage therapy should not be categorized as quackery. Massage can help people relax, relieve aching muscles, and temporarily lift a person’s mood. However, many therapists make claims that go far beyond what massage can accomplish. And even worse, massage therapy schools, publications, and professional groups are an integral part of the deception.

Massage Therapy: Riddled with quackery

Massage therapy has the potential to be a science-based profession, making reasonable claims and of considerable value to many patients. So far, it has fallen well short of that potential in many ways. That has given me a lot to write about!

Skeptism about physiotherapy, chiropractic, massage therapy, and other professions that deal with aches and pains and musculoskeletal health

Unscientific practices in massage therapy may not have a “body count” like some other kinds of alternative health care,5 but they may be just as harmful to your pocketbook, and they may distract you — for years, maybe even forever — from effective, science-based care.

Finding science-based care for injuries and pain problems can be difficult for patients. There are many intellectually immature and pre-scientific ideas6 in musculoskeletal health care. And yet many of them are repeated ad infinitum by all kinds of professionals.

For instance, Physician Richard Deyo of Seattle has spent most of his career publishing in distinguished medical journals trying to educate his colleagues and slay several myths about low back pain that, zombie-like, just won’t die.7 In 2001, the infamous Philadephia Panel published a series of articles that were deeply critical of common practices in mainstream physical therapy.8 And many professionals, lacking training in formal logic and science, routinely confuse correlation with causation,9 with significant consequences. And so on.

I found it impossible not to notice these glaring issues during my training and ever since. I also find writing about them irresistable!

Many ideas in my field remain, to this day, completely unsupported by any research — that the science simply has not been done yet. Musculoskeletal science is basically in its infancy.

Disclaimer: you might stumble on some woo on this website

Forgive me, and let me know, if you stumble across anything “pre-scientific” on SaveYourself.ca. It’s a big website, and I started writing it years before I embraced skepticism. There is probably old writing hanging around that I no longer agree with — it’s hard to keep well over a million words of content fully consistent with my current views.


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.


What skeptics should read on SaveYourself.ca

Greatest hits! Some articles have attracted more attention — and gotten me into more trouble — than other articles. The following four stand out:

  1. SY Do Epsom Salts Work? — There is (still) no good reason to believe that Epsom salt baths aid recovery from muscle pain, soreness or injury. Hardly the most controversial article I’ve written, this is nevertheless the single most popular article on SaveYourself.ca, attracting thousands of readers per month. This seems odd to me. I really have no idea why so many people are searching for information on Epsom salts, but they do, and they land here. They also send me an extraordinary amount of hate mail — that’s right, mail that is hateful, about Epsom salts — potently demonstrating that people do not like to have their beliefs challenged, even when their beliefs are about things as trivial as bath salts.
  2. SY Does Traumeel Work? — A detailed review of Traumeel®, a homeopathic remedy (not herbal) widely used for muscular pain, joint pain, sports injuries, bruising, and post-surgical inflammation. Traumeel also has the distinction of being the most popular of all homeopathic products … and this article about it has consistently been by far the most prominent skeptical article about Traumeel. Ergo, <brag>this article may be literally be the most prominent skeptical article in existence about the most prominent of all homeopathic products.</brag> Not bad, eh? It also generates more hate mail than anything else I’ve ever written. Of course.
  3. SY 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! This is SaveYourself.ca’s original “controversial” article. Stretching was the one of the issues that got me writing. Again using hate mail as a measure of success, I knocked this one out of the park. However, the cranks have an extraordinarily consistent habit of accusing me of holding an opinion I do not actually hold — that stretching is “useless.” Not only do I not say this, but I go out of my way to contradict it. The problem is that the haters rarely read past the first screenful of the article before firing up their flame throwers. Haters are funny that way.
  4. SY Does Chiropractic Work? — Notes from a science-minded massage therapist who gets asked about it every day. Irony: this is not a particularly good article. It has been de-clawed and edited to within an inch of its life for legal reasons. Try to guess what reasons those are! I’ll give you three guesses and the first two don’t count. If you cannot instantly guess, you can’t really call yourself a skeptic yet (but keep working it, baby). In its current, tame form — just a mild-mannered summary of the issues — it doesn’t generate much hate mail. But back in the day, before I knew better than to poke certain beasts, it sure did!

And here’s the rest …

  1. SY My Brain is Tingling! — A comedic diary of my experiences at The Amazing Meetin’ 7 and the Science-Based Medicine conference in Las Vegas, July 8–12, 2009
  2. SY Bogus Citations — References to “scientific evidence” are routinely misleading
  3. SY Dear Scientists — It’s okay to be elitists!
  4. SY Smarter and Funnier — Publication standards for SaveYourself.ca and why you can trust the information published here. I try to make SaveYourself.ca about 800% better than most health care information on the web. Here’s why, and how.
  5. SY Alternative to What? — “Alternative” health care professionals need to decide what they are really the alternative to. This article expresses what I think alternative health care should be, as opposed to being an unscientific substitute for medical care.
  6. SY Does Acupuncture Work for Pain? — Evidence now clearly shows that acupuncture can’t help people with common chronic pain problems, especially low back pain and neck pain. Hot off the press! I’ve only just recently weighed in critically on the subject of acupuncture.
  7. SY Does Massage Therapy Work? — A review of the science of massage therapy … such as it is. A little out of date now, but still a good overview of the issues.
  8. SY Extraordinary Claims — A guide to critical thinking, skepticism and smart reading about health care on the web.
  9. SY Your Back Is Not “Out” and Your Leg Length is Fine — The story of the obsession with crookedness in the physical therapies. This is my thesis, the “big idea” of my career, my pet issue …
  10. SY Does “Lose the Back Pain” Actually Help Low Back Pain? — A review of the popular low back pain treatment system. Nothing irritates me more than bad information about low back pain. In this rather harsh review, I strongly criticize a prominent product.
  11. SY Buyer (of Therapy) Beware — All other things being equal, always choose the cheapest and most comfortable therapeutic option for your pain problem — a vital basic consumer advocacy principle.
  12. SY “I Have Been Humble For Two Decades Now” — A disturbing example of arrogant and addle-brained alternative health care, based on an encounter I had with a therapist with an extremely specific theory about the origin of “all pain.” One hint: it’s in your foot, apparently.
  13. SY Battle of the Experts — A guide for patients caught between conflicting diagnoses and prescriptions. What are health care consumers to do when experts disagree? Disqualifying some of the “experts” as poor sources is a good start!
  14. SY Water Fever and the Fear of Chronic Dehydration — Do we really need eight glasses of water per day? A profile of one of the most irritating and persistent bits of unscientific health advice under the sun.
  15. SY 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. I wrote this one after seeing James Randi speak in Vancouver early in 2009. What fun! Thanks, Mr. Randi!
  16. SY Therapy Babble — Another warning sign of therapy of dubious quality. More curmudgeonly skeptics will enjoy this ranty little article … plus the fantastic comic strips from Cectic.
  17. SY 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. SSRIs are a pet issue of mine, and a great example of how unscientific medicine doesn’t happen only in so-called alternative health care.

Recommended Resources for Skeptics

With a bit of an emphasis on skepticism about health care in particular, but also some of the classic general sources like the JREF, SGU, Skepchick and Snopes…

Skeptic North

Canada’s national skeptical blog, eh?

Scientific journals and other research resources of particular interest to skeptics…

Notes

  1. James Randi Educational Foundation (http://www.Randi.org/) James Randi has an international reputation as a magician and escape artist, but today he is best known as the world’s most tireless investigator and demystifier of paranormal and pseudoscientific claims. The James Randi Educational Foundation is a not-for-profit organization founded in 1996. Its aim is to promote critical thinking by reaching out to the public and media with reliable information about paranormal and supernatural ideas so widespread in our society today. The JREF also sponsors the “One Million Dollar Paranormal Challenge,” which offers a million bucks to anyone who demonstrates a paranormal ability or phenomenon. Since 1964, every single one of about 1000 challengers has either failed the preliminary test, or failed even to agree to acceptable rules for the test. Return to text.
  2. Not only do I get into conversations and debates with individual SBM contributors about their articles, but editing for SBM means that I am also privileged to participate in many group discussions behind the scenes. Thus I am constantly exposed to the thinking of some of the best doctor-writers in the world, as they grapple with the most difficult issues in medicine and skeptical activism. It’s bloody great. Return to text.
  3. We’ve exchanged several personal emails — it’s not a much, I don’t “know” him really, but it does go beyond a polite exchange between a famous guy and a fan. I have had some legal experiences with chiropractors that were of genuine interest to him. He was really cool about it. I also know several other really prominent skeptics for the same reasons. Return to text.
  4. I realized early that I had joined a profession that was not dominated by critical-thinking rationalists. For a long time I struggled emotionally with whether or not I should stay in the profession as an advocate for reform, or just move on and wear my “science journalist” hat full-time. I eventually chose the latter. I closed my massage therapy practice January 1, 2010, to devote myself full time to science writing. Return to text.
  5. When you poll skeptics about their most hated nonsense, so-called alternative medicine is pretty much at the top of their list these days, because of the high stakes. Skeptical luminaries like Dr. Steven Novella (of the Skeptic’s Guide to the Universe podcast) have popularized the idea that unscientific and unregulated health care actually has a “body count” — it kills people, either directly or through neglect of appropriate medical care, as in the case of deaths due to paranoia about vaccines: see the Jenny McCarthy Body Count website. Or consider the homeopathy scandal in the UK, in which the BBC exposed the widespread practice of recommending completely ineffective homeopathic “medicine” in place of genuine anti-malarial medications. Although the stakes are lower in my own field, there is one exception: evidence shows that cervical spinal manipulative therapy — neck cracking — performed by chiropractors may be lethally dangerous (see Smith). Even chiropractic authorities agree that “there are considerable case studies describing the onset of vertebral artery injury following a manipulation” (Triano). For a more detailed look at this topic, see What Happened To My Barber? Return to text.
  6. What I mean by “pre-scientific” ideas is twofold: first, I mean ideas that were spawned before medical science had taken root in the world (such as the “Big Idea” of chiropractic, that spinal problems cause all disease); and second, I mean that a great deal of basic science about pain problems simply has not been done yet. Return to text.
  7. Deyo et al. New England Journal of Medicine. 2001. Although now several years old, this is still an excellent tutorial for health professionals, offering a thorough and sensible survey of current medical knowledge about low back pain. Deyo and Weinstein are strongly critical of overmedicalization and excessive imaging and surgery for low back pain, and emphasize the favourable prognosis for most back pain, the poor correlation between imaging results and symptoms, and the absence of any clear pathophysiological mechanism to explain most low back pain. Their key points have been reinforced by more recent scientific evidence. Return to text.
  8. Davis. Physical Therapy. 2002. A fascinating letter (plus replies) to the editor of Physical Therapy, regarding the October 2001 issue, which published the “shocking” results of the Philadelphia Panel, showing that “so few of the modalities that we have come to believe in actually show evidence of efficacy in controlled trials.” See “Philadelphia Panel evidence-based clinical practice guidelines on selected rehabilitation interventions: overview and methodology”. Return to text.
  9. For instance, a tendency to assume that pain must be caused by minor anatomical abnormalities observed in the same patient. But such abnormalities are so common that they are present in most patients to some degree, and even the correlation breaks down with a little more careful observation — other patients with the same symptoms lack the crookedness, or they have a more prominent abnormality but lack the symptoms. For more information, see Your Back Is Not “Out” and Your Leg Length is Fine: The story of the obsession with crookedness in the physical therapies. Return to text.