PainScience.com (Paul Ingraham)

Manual Therapy: What is it, and does it work? The science of hands-on treatments like massage and spinal manipulation to “fix” tissue.

Will try to read that with an open mind, but the field of manual therapy is so polluted with self-serving, low-quality reasoning and research that I have become profoundly cynical about any claims about its medical benefits.

www.painscience.com/manual_thera...

Excellent, thank you!

I mean, what DOESN'T make people with orthostatic intolerance feel oogy, amiright? 😜 But yeah, stretching practically designed to be a POTS trigger.

"Part of a healthy lifestyle"! There's the likely explanation for the correlation right there in subtitle: people who stretch are the kind of people who probably do a bunch of other things that are much more beneficial. People who have time for a stretching habit also often privileged in MANY ways.

Warneke et al. did quite a nice job of making their recommendations goal-oriented. "If you want X, then this is what we all say to that …"

My publishing has slowed to a crawl lately. Time to say why: multiple family health crises, some more serious/ongoing, but the “perfect storm” factor ever since the early winter has been…impressive. ☹️

Despite the storm, I have gotten SOME work done, and good things are coming to your inbox soon.

Screenshot of a scientific paper’s abstract page showing the title “Practical recommendations on stretching exercise: A Delphi consensus statement of international research experts” with a list of 20 authors including Konstantin Warneke, Ewan Thomas, Anthony J Blazevich, and others, and a list of “highlights” containing 8 bullet points, which are as follows: Consensus was reached in providing uniform definitions for static stretching, dynamic stretching, and proprioceptive neuromuscular facilitation. Stretching is recommended to improve range of motion, both acutely (single session) and chronically (long-term training), although alternative interventions (e.g., resistance training) are available. Stretching acutely and chronically reduces muscle stiffness, but it is questionable whether this is a desirable goal. Stretching seems largely inefficient as a post-exercise recovery strategy. Stretching does not reduce overall injury risk. In some cases, it may reduce the risk of muscle injuries but with the possibility that it may be compensated for with more bone and joint injuries. Stretching may produce small effects on chronic strength gains and muscle hypertrophy but requires high doses and is much less effective than resistance training for this effect. There are potential benefits of stretching for the cardiovascular system, but more research is required before clinical recommendations can be issued. Stretching does not promote relevant postural changes.

Twenty stretching experts pooled their expertise for an ambitious consensus paper. The clickbait headline for this would be “The Great Stretching Myth: 20 Scientists Reveal What Actually Works — and What Doesn’t.” And it doesn’t work for much!

NEW POST, 3m read:

www.painscience.com/blog/stretch...

Sooo … another post about the necessity of nociception thing? 😱 Again! Sorry! But the whole reason I’m returning to the topic is that I do NOT think it’s just a word game. It is part of an important ongoing debate about whether psychosomatic pain exists.

www.painscience.com/blog/is-it-m...

Yep, that's my kind of content, thanks! I cancelled my WaPo subscription a year ago, but still have access indirectly via another subscription.

So, uh, what is CES anyway? I'll admit it - it took me a long time to understand what cauda equina syndrome actually is. In researching our CES book, I learned that this is not unusual! I spoke to a lot of clinicians about CES, ...

Image is from Tom Jesson’s superb primer on cauda equina syndrome: “So, uh, what is CES anyway?" Excellent additional reading:

shop.tomjesson.com/blogs/blog/s...

An updated red flag for a rare type of back pain Pain + weakness in both legs is the new best warning symptom cauda equina syndrome

👉🏻 is CES so rare it’s a “once in a career” condition?

The full post:

www.painscience.com/blog/updated...

Can we do better? Something a little more specific, more reliable? Probably, yes! Today I have a solid evidence-based update on this topic:

👉🏻 the best new CES red flags
👉🏻 the old ones that aren't so good

Plus interesting digressions about …

👉🏻 anus strength (seriously)

A traditional CES signature symptom, a classic red flag for the condition, occurs JUST AS OFTEN as it does in people who do NOT have that back problem … and that isn’t great look for a red flag. Ideally, red flags don’t represent quite so many false alarms.

Posterior view anatomical illustration showing lumbar and sacral nerve roots descending through the spinal canal as the cauda equina. The red nerve bundle is labeled ‘central herniation’ at the L5-S1 level, with annotation indicating it ‘affects S2,3,4’ nerve roots. The illustration demonstrates how a central disc herniation can compress multiple sacral nerve roots simultaneously.

An updated red flag for a rare type of back pain…

Cauda equina syndrome (CES) is caused by compression of the horsetail-looking end of the spinal cord. It is a fairly rare kind of back problem, and sometimes very serious.

And the classic red flag for it…ain’t great! 🧵

Self-Reported Hip Crepitus Is Prevalent in Football Players With Hip/Groin Pain, but Is It Associated With Early Hip Osteoarthritis Structural Features? A Longitudinal Study | Journal of Orthopaedic &... OBJECTIVES: (1) To compare the prevalence of self-reported hip crepitus between football (soccer and Australian football) players with and without hip/groin pain. In players with hip/groin pain, to (2...

The crepitus was only associated with number of cruddy cartilage subregions—NOT morphology, NOT labral tears, NOT change in 2 years—which suggests that the noise is only a modest marker of cartilage involvement, not a smoking gun for arthritis progression.

www.jospt.org/doi/10.2519/...

Does whatever causes the crepitus also inevitably cause pain? Or does pain just make people notice crepitus more? Are both a consequence of the underlying pathology? And although they found ONE strong association …

That is a striking correlation. A prevalence of 5.0 with a confidence interval of 2.5–10.2 means at LEAST 2.5× higher prevalence — well above chance. They’re related SOMEHOW.

But how? As ever, evidence of an “association” in cross-sectional data only gets us so far …

Are noisy joints arthritic? Is “crepitus” associated with early signs of osteoarthritis?

YES. They are indeed “associated,” and quite strongly, in a new study in JOSPT. Footballers with hip/groin pain were 5× likelier to report hip crepitus (popping and grinding noises).

It’s been a bit of a struggle here to find content to share about physical medicine and pain science.

So how about this absolutely fabulous galaxy instead?

Sneaky soft-tissue fragility: a new article Many underdiagnosed health problems reduce the resilience of muscle and connective tissue, increasing the risks of “deep” massage

Not everyone is sturdy enough for a “deep” massage—not even seemingly healthy people—due to many sneaky, underdiagnosed pathologies, genetic quirks, and medication side effects that make tissues physically FRAGILE.

New article! PainScience.com/blog/sneaky-soft-tissue-fragility--a-new-article.html

PainScience It’s Blocking Day! That special time when I review my most controversial posts here on Facebook and block some trolls that have been on my naughty list for a while. If you’re reading this, obviously....

It’s Blocking Day over on Facebook. Just purged a bunch of trolls that emerged over the last few months. Just wrote about it. Facebook link, because that's really where all the commenting/trolling/blocking action has been for me for years:

www.facebook.com/painscience/...

Grumpy cat meme: a very grump cat with the caption: “Social media? I like antisocial media better.”

I need a word for the PAIN of having the perfect snarky comment to take down some smug putz on social media … but you can’t use it because you have promised yourself to always, no matter what, “keep it classy.” *sigh*

What a perfect fit for the gross new CBS News. And Huberman too?! Ew ew ew ew ew. 🤮

Yep. 🫶🏻

I share WeRateDogs posts sometimes, just because I ❤ dogs. They are rarely relevant to pain or physical medicine. Almost never. But THIS? This is about has therapy, dogs, AND cats too. And I also ❤ cats! So … perfect storm really. MUST SHARE.

There are days when I fantasize about turning to the Dark Side.

Days of mist and fog in Vancouver. And it has just a little colour right now.

For 15 years now, I’ve eked out a living writing very skeptically about all the nonsense in healthcare for pain and injury rehab. But … emphasis on “eked”! I have come close to calling it quits several times.

Sometimes a baguette is just a baguette…

Please! Stop saying trigger points do not “exist” (plus a needling study) Today’s post is my first about “trigger points” in quite a while. It’s got two parts, loosely related: PART 1: A…

PART 2—A report on a new study of treating TrPs with acupuncture needles showing that it works…much like tenderizing meat? They also failed to find any “contraction knots,” but did find OTHER signs of unhealthy tissue.

PainScience.com/blog/please-stop-saying-trigger-points-dont-exist.html