Massage & Fitness Magazine, LLC

19/06/2024

From an old blog by Dr. Bronnie L. Thompson about the psychosocial factors of kinesiophobia, the fear of movement.

"...in a phobia, a person holds an unconfirmed and (usually) unrealistic belief that some sort of disaster will occur if they encounter the feared stimulus.

"In kinesiophobia, this belief can be complicated by the degree of meaning that people hold about experiencing pain – not only are individuals probably correct in their belief that if they move they may experience pain, but from childhood we have been trained to avoid experiencing pain because it is equal to harm or damage.

"The problem for people with chronic pain who also have kinesiophobia is that the movements may exacerbate pain but the pain they experience no longer represents harm or damage...

"What are we reinforcing in our patients when we encourage them to notice their pain, report on their pain, medicate their pain – maybe we’re actually reinforcing their fear that something awful will happen if they experience a fluctuation in their pain? Or maybe we are fearful of seeing someone experiencing pain?"

https://healthskills.wordpress.com/2009/08/25/safety-behaviours-do-they-maintain-kinesiophobia/

18/06/2024

Human anatomy is variable, as in most biological forms. We are not "perfect" like what we see in anatomy charts nor are our parts uniform like car parts in an assembly line 🙂

See below 👇🏽

02/06/2024

The ecological-enactive approach to pain extends the

• Clinical reasoning and practice centers around affordances: opportunities for action.

• Disabling pain is experienced as closed-off or “stuck” field of affordances.

• Therapist and patient work together to make sense of pain, complexity, and uncertainty.

• Together, they choose interventions aimed to “open-up” the field of affordances.

Affordances are opportunities for action that the environment offers a person. For example, a chair's sit-ability and stairs' climb-ability are typical affordances for adult humans, influenced by their body shape, functions, and sociocultural practices. The set of affordances available to a person or social group depends on their abilities, practices, and living environment.

In an ecological-enactive approach, pain is understood by looking at what actions a person thinks they can do in their environment. When someone has chronic pain, they often feel trapped and find it hard to do things they used to.

For example, sitting on a chair or climbing stairs might seem too painful or dangerous for someone with bad back pain. Pain can also make time feel slower and spaces feel smaller.

When someone has , their body feels like an obstacle, making everyday tasks difficult. They might stop believing they can do certain things and become less active. They feel stuck and frustrated because others don't always understand why they avoid certain movements or tasks.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10632936/

23/04/2024

Researchers at the University of Washington School of Medicine in Seattle have discovered that activating a small group of brain neurons induces a reaction in mice resembling nociplastic pain, a type of chronic pain that lacks a clear cause.

“When we stimulate these neurons, the mouse behaves as though gentle touch is very painful, which is one of the characteristics of nociplastic pain,” said Richard Palmiter, a professor of biochemistry and investigator of the Howard Hughes Medical Institute.

Although the origin of nociplastic pain remains elusive, scientists theorize that it involves changes within the pain pathways of the spinal cord and brain, leading to the perception of pain in the absence of nerve damage.

In their recent investigation, they demonstrated that activating a specific group of cells within the brain's parabrachial nucleus can elicit persistent pain behaviors characteristic of nociplastic pain. They also showed that inhibiting these cells can prevent pain resulting from nerve injury.

Inside the pons region of the brain, the parabrachial nucleus serves as a central hub for transmitting unpleasant sensory signals from the body to various brain regions. The neurons within the parabrachial nucleus implicated in generating nociplastic pain are identified as Calca neurons, derived from a key gene defining these cells.

Stimulating a small cluster of neurons in the brain appears to create a response in mice that mimics nociplastic pain, a type of unexplained chronic pain that can affect people, researchers at the University of Washington School of Medicine in Seattle have found. 

05/03/2024

While there’s no evidence that specific pelvic or low back exercise can alleviate cluneal nerve pain or entrapment, exercise in general may reduce pain sensitivity.

A 2022 systematic review of 11 studies show that aerobic exercise (e.g. step aerobics, walking, cycling) could reduce chronic musculoskeletal pain, but the researchers do not know if such pain reduction also improves disability and quality of life.

https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-022-05047-9

However, strength training alone has also been shown to be just as good as aerobics for alleviating chronic low back pain (which may be good news to those who don’t like to do aerobics).

https://pubmed.ncbi.nlm.nih.gov/29889056/
Does it matter which type of exercise? The current evidence says no. What matters more is the exercise routine is consistent and enjoyable. Research may be needed to see if the existing exercise for chronic pain research could be applied to cluneal nerve pain.



https://massagefitnessmag.com/massage/cluneal-nerve-entrapment/

Cluneal nerve entrapment may be a main cause of low back pain, but the lack of scientific evidence makes treatment and diagnoses challenging.

20/02/2024

2025 would have been my 10-year anniversary of attending the first official San Diego Pain Summit, but founder Rajam Roose announced yesterday that 2024 will be the final year of the pain summit.

Over the years, I had met many fellow colleagues and various healthcare professionals in person from around the world, including those from the Phillipines, Brazil, India, Netherlands, and Portugal, as well as those from across the U.S. and Canada.

For many massage therapists, SDPS filled in a large gap of education that many did not receive in their massage training.

What was unique to me about the pain summit is the social activties after the events. How can we apply these research to practice? How can we reframe the way we think about our treatment and communication skills to patients and clients?

How can we provide more inclusivity in our care? Why should we even bother understanding modern pain science?

Ten years later, we're still struggling with these questions and many more.

The first story I covered was the 2016 SDPS with keynote speaker Dr. Robert Sapolsky from Stanford University, who talked about how humans take stress to a whole new level that is unprecedented by other species of animals.

Hopefully, those of us who want to see a change in our practices and the system will continue the legacy of the San Diego Pain Summit.

Well, we are doing our (small) part. 🤟🏽

Cheers,

Nick Ng, editor of Massage & Fitness

https://massagefitnessmag.com/events/2016-pain-summit-rocked-san-diego-with-its-second-year/

The San Diego Pain Summit enters its second year with Prof. Robert Sapolsky as the keynote speaker. Other speakers: Fabrizio Benedetti, Bronnie Thompson,

14/02/2024

Deeper is not necessarily better. ☝🏽

Dear Editor

11/02/2024

"Despite many success stories with CST, mainstream medicine has not embraced this type of therapy for a few reasons. Although some research shows positive effects, it’s often hard to separate the reported results from placebo.

"If you’re experiencing pain or anxiety and attend a treatment session with breathing techniques, light massage, and a calming atmosphere, it may not be a stretch to come out of the session feeling better or more relaxed—especially if you’re being touched.

"CST does not have standard techniques or procedures. Practitioners use varying methods which makes it difficult to design rigorous scientific investigations. Unfortunately, there’s no consistent, reproducible approach to treatment in CST.

"Also, from a biological perspective, the gentle manipulations of CST are unlikely to influence the flow of cerebrospinal fluid. Even if they were, the idea that the flow of cerebrospinal can bring about the type of health benefits CST claims is not consistent with what is known in modern healthcare." ~ Dr. Penny Goldberg

Traditionally, craniosacral therapy (CST) is a gentle type of manual therapy that focuses on treating the membranes and cerebrospinal fluid that surround the brain and spinal cord—collectively, the craniosacral system. Practitioners use light touch to release tension and stress, believing low ampl...

29/01/2024

Do not mistake short-term changes and word salad as indications of a good clincian or practitioner.

Good communication and listening skills are likely more important than the tools or techniques in most manual therapy treatments.

Quote from Dr. Cameron Faller PT, DPT, CSCS

https://www.instagram.com/p/C2s5MZNPinN/?img_index=1

25/08/2023

Are you tired of us posting about and ?

Well, we're also very tired of seeing the myths about posture relating to , , and other types of pain since the 1990s when NSYNC and Spice Girls were popular.

Once again, there's no strong evidence in the last 30+ years that the anterior pelvic tilt is a major cause of low back pain and hip pain.

All these beliefs about upper cross syndrome and lower cross syndrome are based on hypotheses by Dr. Vladimir Janda, who was a Czech neurologist and physiotherapist.

While his ideas about was novel at the time (1970s-1990s), people who followed him never expanded or critically examined his hypotheses like other scientific ideas.

And so, we're in the 2020s, and we still see and hear messages on Instagram, TikTok, Twitter (or X), and other social media platforms where physios, chiros, , and spread these ideas that aren't consistent with the body of research.

From Dr. Jason Silvernail in 2019: "Janda had some great theories and useful clinical processes. To think these syndromes are the beginning and end of his thought is crazy. Such a small part of the overall system and process he advocated.

"But many people think ‘Janda=Cross syndromes’ and that’s as silly as ‘Pain science means you just talk at your patients.’

"Most people who criticize Janda (McKenzie, Maitland, Moseley, etc) haven’t actually read what they wrote. He was so far ahead of his time in so many ways. Janda had so many more insights as well. Way more than the simplest interpretation of crossed syndromes.

"I would guess most people ‘teaching Janda’ in the sense you describe have not read what he actually wrote.

"I like to ask people that sort of thing: I see you’ve referenced Janda here for your crossed syndromes material. It doesn’t seem consistent with his work. What is the source of this material? Which of his books have you read that supports this?

"People do the same thing today with criticism of ‘the pain science approach.’"

08/08/2023

I first learned about the back in late 2000 at Aztec Recreation when I enter my first bench press contest at the gym.

I thought if I could pump 200-plus pounds on the chest press machine, I can also bench 200 pounds.

I was TOTALLY wrong.

I was one of the first few people to be disqualified when I couldn't even bench one rep with two 45-lb plates on each side, which is LESS THAN HALF of what I was doing on the chest press machine.

But I stuck around to watch the rest of the guys compete, and to my surprise, (if I remember correctly) the third place winner was a lean, Filipino guy with one hand. His left arm ended in a stump and two digits that allowed him to grip things.

A few years later as a personal trainer, I finally understood what specificity in training means: you get better at certain things that you're specifically trained to do.

https://massagefitnessmag.com/fitness/said-principle/

So, if you want to improve your lower-body strength for (American) football, do sprints or sled pushes. If you're recovering on a leg injury and resume jiu-jitsu training, perhaps the leg press would help before you spar with an opponent.

30/07/2023

“A human being’s posture is NOT akin to the alignment of an automobile and should NEVER be seen as such,”

A posture brace may likely help those with severe or other types of spinal deformities that can affect breathing and movement.

But these devices were never meant to be used to "fix" someone's to avoid .

Currently, there's no strong scientific evidence that wearing one can prevent or reduce , , or related pain.

But based on what is currently known about pain, it stems from a combination biological, psychological, and environmental factors, never just one ( ).

27/07/2023

Researchers from Curtin University in Australia examined the necks of 1,100+ teenagers by using photoreflective markers found that the shape of the neck and upper back aren't major influencers of .

Instead, they found the following to be high predictors of such pain:

* body mass index (BMI)
* exercise frequency
* sleep quality
* stress
* depression



https://massagefitnessmag.com/massage/forward-head-posture/

Original study: https://academic.oup.com/ptj/article/96/10/1576/2870247

26/07/2023

Predictive factors that increase the likelihood of disc reabsorption.

Just published 🔥

Systematic review and meta-analysis of predictive factors for spontaneous regression in lumbar disc herniation 💡

👉Relatively little evidence exists on predictive factors for the spontaneous regression of lumbar disc herniation (LDH), although it is a well-documented phenomenon. Without specific intervention, two-thirds of patients can expect disc regression, with 85% attaining symptom resolution within 1 year. https://brjp.org.br/article/doi/10.5935/2595-0118.20210067, https://pubmed.ncbi.nlm.nih.gov/28072796/

❓ But which patients can expect such a regression?

📊In a brand-new systematic review Rashed and colleagues included 16 studies describing 360 cases of lumbar disc herniation regression. The majority tended to be younger and male and presented with radiculopathy and L4–5 or L5–S1 disc herniation. The mean time to follow-up imaging was 11.5 months, and MRI was used as the imaging modality for all. https://thejns.org/spine/view/journals/j-neurosurg-spine/aop/article-10.3171-2023.6.SPINE23367/article-10.3171-2023.6.SPINE23367.xml

📊The probabilities of spontaneous regression with bulging, protruded, extruded, and sequestered discs (definition and figure, s. below) were:

👉 Bulging: 13.3%
👉 Protruded: 52.5%,
👉Extruded: 70.4%, and
👉 Sequestered: 93.0%, respectively.

📌 Extruded and sequestered discs were also significantly more likely to completely regress than smaller morphologies.

Other predictors of regression were:

👉 Larger baseline herniation volume (1260.16 vs 1006.71 mm3, p < 0.002),

👉 transligamentous herniation (herniations that had perforated through the posterior longitudinal ligament, PLL, p < 0.001), and

👉 higher Komori types (stronger migrating of disc herniation, p < 0.001).

❓ What are the proposed mechanisms?

💡 A number of mechanisms for spontaneous regression have been proposed, but the most supported theory is that of on autoimmune response to herniated disc fragments in the epidural space promoting neovascularization, macrophage infiltration, and ultimately phagocytosis of disc material. https://pubmed.ncbi.nlm.nih.gov/36722839/, https://pubmed.ncbi.nlm.nih.gov/35999644/

💡 It is thought that this response is exaggerated in the presence of a sequestered fragment, which is why PLL rupture is associated with regression. https://pubmed.ncbi.nlm.nih.gov/36722839/

❓ What about the relationship to symptoms?

👉 The association between symptoms and LDH regression is less well defined in the literature but is generally assumed to be positive. This was demonstrated in all qualitative studies in this review as well as in the majority of those in the previous review. https://pubmed.ncbi.nlm.nih.gov/25009200/
More interestingly, the authors describe 2 papers that show significantly increased disc regression on MRI if symptoms have been present for a shorter duration (< 1 year vs > 1 year). https://pubmed.ncbi.nlm.nih.gov/29945407/, https://pubmed.ncbi.nlm.nih.gov/34323452/

📌 This finding correlates with the improved outcomes seen with shorter symptom duration (< 12 months) in both surgical and non-surgical cohorts in the largest trials to date. https://pubmed.ncbi.nlm.nih.gov/22012528/

Classification of disc herniation: https://pubmed.ncbi.nlm.nih.gov/24768732/

A BULGING DISK refers to the generalized or focal extension of disc tissue, usually < 3 mm from the vertebral body apophysis, and is considered a normal variant.

A PROTRUDED DISK extends > 3 mm beyond the apophysis, but importantly, its herniated dimen-sions do not exceed those of the remaining disc within the disc space.

This is unlike EXTRUDED DISKS, in which at least one plane of herniated disc tissue exceeds disc space dimensions and usually extends through the posterior longitudinal ligament (PLL).

A SEQUESTRED DISK is a variant of extruded discs whereby a portion of the disc fragment is displaced beyond the outer annulus and maintains no connection with the origin disc tissues.

MIGRATED DISKS are those with extruded segments displaced away from the outer annulus and can be extruded or sequestered in morphology.

Illustration: https://www.nejm.org/doi/pdf/10.1056/nejmcp1512658

25/07/2023

“First, some people are more flexible than others—like children—and their body can adapt to the anatomic inequality. The body seems to be able to compensate for relatively small amounts of true anatomic inequality,

“Second, pain can be the result of a functional or physiologic inequality and not anatomic. Thus, anatomic leg-length inequality may be present, but the pain is the result of functional leg length discrepancy pathophysiology, not the result of the anatomical leg length discrepancy.

“When there is pain involved in the kinetic chain, leg-length inequality is often poorly measured, and that measurement gives no distinction between anatomic and functional leg length discrepancy. So, what is a functional problem is often blamed on an anatomic one, and vice-versa.” ~ Gary Knutson, DC (2017)

https://massagefitnessmag.com/fitness/should-you-fix-leg-length-discrepancy/

23/07/2023

Some people think that a larger Q angle increases the likelihood of getting knee pain from valgus knees, but research finds that it’s not as likely as you think.

For example, researchers from the University of Buffalo in New York found that people with Q angles greater than 17 degrees did not have a greater knee valgus angle during a single-leg squat than those with Q angles less than 8 degrees.

This suggests that variations in bony anatomy alone are not necessarily cause for concern when it comes to knee pain.

Also, a study of 22 women with patellofemoral pain syndrome (PFPS) was unable to find any correlation between the Q angle and pain intensity, functional capacity, or dynamic knee valgus.

https://massagefitnessmag.com/massage/q-angle/

09/07/2023

"Functional training" implies that there is "non-functional training," argues some scientists.

In 2022, a team of Brazilian researchers published a review that examined the definition and nature of , including the terms “functional fitness,” and “high-intensity functional training.”

They examined 20 trials with these terms from the year 2020 and onward. The pooled studies have huge variations in subjects, experiment protocols, and exercise factors (e.g. type, duration).

They concluded that “the terms ‘functional training,’ ‘high intensity functional training,’ and ‘functional fitness’ no longer describe any physical training program.” This is due to the unspecific nature of the term itself. And so, functional training should not be seen as an all-encompassing approach to health and fitness.

Functional training is a form of exercise that mimics daily activities or sports movements. But research questions its defintion because it's misleading.

02/07/2023

A majority of the research since the 1990s show little to no association between the shape of your neck and neck pain.

In some trials, researchers hypothesize that the forward head posture is an adaptation among some people to avoid pain.

And there's so much variation among younger and older people, men and women, and lifestyle that there's no consistent and strong evidence that neck posture is a primary cause of neck pain.

https://massagefitnessmag.com/massage/forward-head-posture/