Monica Noy on Cognitive Dissonance

I really admire Monica Noy’s writing.  This piece displays a good deal of bravery on her part.  She dispels craniosacral therapy as quackery, which is all the more impressive seeing as how she studied this very modality intensively throughout her own schooling, and therefore did have, at one point, a vested interest in promoting its use.

You Don’t Win Friends With Cognitive Dissonance.

“Talk about cognitive dissonance.

Palpation reliability – not a thing. It has nothing to do with lack of evidence, and everything to do with a lot of evidence that has consensus of a negative result.

Cranial bone mobility – not a thing. Now some will say that studies show pliability of the suture like that changes something. And studies do indeed show pliability of the suture, but it changes nothing because what does it really mean to have pliability at the suture? How does that pliability become osteopathic cranial mobility? Short answer, its functional for cranial growth and it doesn’t mean shit for osteopathic cranial bone mobility.

PRM – not a thing. Rhythm, rate, expression and mechanism not established, highly debated, lots of alternate hypothesis, some more or less supported by physiology but nothing resembling the currently established parameters.

Normal cognitive function – oh, that’s a thing. And if that’s a thing, a normal thing, what does it really mean to be a human with normal cognitive function? Short answer, it means that if we don’t really truly THINK about it, we will construct a reality that fits our desire. Even shorter answer, we are egotistical first, thoughtfully reflective someways down the road, maybe.”

No association between low back pain and lumbar spondylolysis with or without isthmic spondylolisthesis!

This is huge news.  The link below is to a systematic review which has concluded that low back pain is NOT related to lumbar spondylosis which is a mechanical deformity often found in the lumbar spine.  It is very common.  As of right now, 2016, there are a ton of surgeons, MD’s, chiropractors, and many other health professionals, that will suggest to patients that they are in pain or should be in pain due to these deformities..  This sort of thinking actually increases fear of movement in the patient and/or produces a “nocebo” effect, which is scientifically proven to actually worsen outcomes.  Oh the irony!

“And another structural diagnosis is found to have no association with pain… How many more of these are needed before this message becomes widely accepted in the medical and public arenas?” – Adam Meakins

5 Myths about Chronic Pain

An excellent article dispelling some common myths with regards to chronic pain:

“It is like a radio; if you turn up the volume, it does not mean the announcer is speaking louder, it just means that you are amplifying the sound.

Similarly, if the nervous system is sensitive, it is amplifying signals to the brain, which results in more pain — regardless of how much tissue damage there is.

We also know that things that fire together, wire together.

So if you often feel anxious when there is a twinge of pain during movement, then the areas of your brain that activate with movement, anxiety and pain all get very good at firing together.

This means that just movement or anxiety can activate this anxiety-pain-movement brain network. So you feel pain, without there actually being a danger signal from damaged tissue.”

Book Review – Supple Leopard

Becoming a Supple Leopard by Kelly Starrett: Book Review

“After reading this part, I honestly didn’t want to read anymore. This was one of the best examples of fear mongering and bad science that I have read. He is literally taking your hand and walking you back to the dark ages of physical therapy of the 1950’s, when we used to believe pain comes from joint, tissues, bad posture and movement.”

Don’t Bruise Clients

“a growing number of physio and massage therapists who doubt there is credible evidence that purely mesodermal deformation is responsible for the therapeutic effects we obtain in manual therapy. Instead, they are generally satisfied that it is nervous system interactions that are the driving mechanism for pain relief and therapeutic effects, modulated by biopsychosocial factors. Furthermore, many also claim that manipulation deeper than the ectoderm is unnecessary and possibly not optimal. In that viewpoint, bruising would be considered excess force.”

Expectation Fulfillment Confounder

Another confounding variable when it comes to determining whether a particular therapy is effective or not is the EFC or Expectation Fulfillment Confounder.  Which, along with Confirmation Bias, Placebo, Regression to the Mean and other Confounding Variables, makes it next to impossible to determine whether a particular therapy is working through clinical evidence only.

“But hold on!  We have to be careful here.  Stability wasn’t measured.  Just self reports of stability.  And we don’t know what the patients were told.  If they patients felt that they were unstable, were told that they scored high on self report measures on instability and then were given an exercise program that they were told addresses motor control deficits that contribute to stability with have an Expectation Fulfillment Confounder (EFC).  Its not unusual that this subset would respond better because they have been primed to respond better. – Greg Lehman

Flexibility is overrated

Flexibility is overrated, just like good posture. Gymnasts and acrobats need it, the average person doesn’t. Most people need greater power and control throughout their existing range of motion: that’s much more useful for performance and injury prevention.

Another critical concept is that stiffness is a sensation, not a physical property. People think they need to be more flexible because they feel stiff, but that sensation is rarely related to actually limited range of motion. Stiffness is more like a kind of chronic pain, difficult to troubleshoot, much more complicated than range of motion.”

-Paul Ingraham –

LLLT for Degenerative Foot Conditions

From Meditech International’s Winter 2015 Newsletter, on the subject of degenerative changes in the foot: “(LLLT) can increase angiogenesis, which is the formation of small collateral arteries, arterioles and capillaries resulting in increased arterial perfusion.  These physiological activities will increase the blood supply to the foot.  In turn, this has the potential to counter some of the secondary effects that occur in the ageing process and accelerate the regenerative process.  Laser Therapy can offer a myoprotective effect, preventing the apoptosis of myonuclei.  As such, prolonged course of Laser Therapy directly and positively impacts the majority of the problems of the ageing foot.”

Elite Athletes + Interoception, Resilience + Chronic Pain

….elite athletes are very good at interpreting their own body signals in order to maintain their activity level within both biomechanical and metabolic limits. Ultimately, this ability enables them to cope with highly stressful situations without getting hurt. As often happens, the relation of causality between body awareness and being an athlete[*] is not clear, but nonetheless a link does exist

Given the close link existing between interoception and resilience  [1], and that chronic pain patients have indeed a poor representation of their affected part (see, for example [6]), low interoception/low resilience might have a crucial role in the development and maintenance of chronic pain. In other words, perhaps it is possible that when generally low interoceptive/low resilient individuals experience a stressful situation (e.g. a sprained ankle), they are unable to efficiently deal with the corresponding interoceptive signals….