77 Tightly Guarded Health Secrets: Home Remedies that Really Work
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Meanwhile, many people with perfectly obvious biomechanical problems — everything from significant scoliosis to obesity — are doing just fine, thank you very much. How can they miss it? Simple: unfortunately, it pays to miss it. It pays to have structural villians to go after. It pays to pathologize. Irregularity is to be expected in any biological form. Body parts are not interchangeable legos or Ikea furniture pieces made by factory molds.
Wonkiness and asymmetry are part of the plan. Natural biomechanical diversity undermines clinical mojo. It is difficult to get a man to understand something when his job depends on not understanding it. The Upton quote could not possibly be more applicable. Adapted slightly: It is difficult to get a therapist to understand that structural abnormality is rarely meaningful when his job depends on ignoring this data and actually emphasizing structure.
Once you start mentally leaning towards the idea of asymmetries as a major cause of pain, you start noticing and emphasizing only the cases that seem to confirm that expectation … and ignoring the ones that contradict it. The basic problem with structuralism is that biomechanical factors have surprisingly little to do with pain problems. The two things correlate poorly.
But structuralism is deeply embedded in our cultural consciousness, and we cling to the idea that aligned and symmetrical must be the best way to be, and we suffer in proportion to our deviations from that diagram. There is a lot of hard evidence and the most expert possible opinions to back me up. Nor is it an extreme position to defend: I do not need to convince you that both baby and bathwater should be thrown out together.
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My work here is done if I can just convince you that there is reasonable doubt that biomechanics are a major factor in most pain. For instance, San Francisco orthopaedic surgeon Dr. Scott Dye has written eloquently about how ill-advised structuralism is when it comes to knee pain. Back pain experts Drs. Richard Deyo 24 and Nickolai Bogduk 25 have virtually devoted their careers to teaching doctors not to overestimate the importance of biomechanical factors in back pain.
Moreover, disc degeneration, spondylosis and spinal osteoarthrosis correlate poorly with pain and may be totally asymptomatic. There is probably no other medical condition which is treated in so many different ways and by such a variety of practitioners as back pain.
Though the conclusion may be uncomfortable, the medical community must bear the responsibility for this, for is has been distressingly narrow in its approach to the problem. It has been trapped by a diagnostic bias of ancient vintage and, most uncharacteristically, has uncritically accepted an unproven concept, that structural abnormalities are the cause of back pain. Neurology and neuropathy, homeostasis, subtle pathology, biological vulnerability. There are all kinds of tissue issues that may have little or nothing to do with structure, aligment, and biomechanics at all.
You could include any researcher who has ever identified anything that goes wrong and causes trouble and pain that is not structural or biomechanical in nature. For instance, in , biologist Paul Kubes published a great example of fascinating evidence that inflammation may become chronic due to a glitch in human immune systems. Or Dr.
The case against structuralism
Or the major contributions to the science of fibromyalgia by Drs. Fred Wolfe and Daniel Clauw. Or the other Woolf, Dr. Clifford Woolf, who has contributed so much to our understanding of central sensitization. And so on and on. There are many potential mechanisms of pain that have little or nothing to do with posture, alignment, and structure — and an army of researchers and other experts who have been pushing beyond that very limited view of how pain works.
Sassy Aussie pain researcher Dr.
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This perspective has been spreading like wildfire. Janet Travell , Dr. David Simons and Dr. Simons in particular wrote extensively and passionately about the neglect of muscle as a source of pain:. Muscle is an orphan organ. No medical speciality claims it. As a consequence, no medical specialty is concerned with promoting funded research into the muscular causes of pain, and medical students and physical therapists rarely receive adequate primary training in how to recognize and treat myofascial trigger points.
In order to spot a physical flaw that needs to be corrected, one must begin by having a reliable measure of whether or not it is actually problematic in the first place. Many key scientific studies over the years have undermined major structuralist assumptions. Some of the evidence is direct. There is a strong pattern of all kinds of evidence converging on the same conclusion: structuralism does not produce effective therapies. My favourite direct evidence — not the best, but my favourite — has always been the simple leg length study published way back in , in the venerable British medical journal Lancet.
It showed that leg length differences were unrelated to back pain — no correlation even, let alone a causal relationship. Wear and tear? Not so much.
Your Back Is Not Out of Alignment
This fundamentally mechanical view of arthritis directly suggests that the longer we live and the heavier we are, the more likely we are to have joint trouble. But we know that knee osteoarthritis prevalence has doubled in the 20th Century independent of age and weight. Something else is going on.
We need to be looking at neurology and immunology inflammation. This is a well-studied question, and a systematic review of more than 50 studies found no association between measurements of spinal curves and pain. An excellent example is a failure of the Functional Movement Screen to detect actual recent injuries , let alone any subtle or specific biomechanical risk factors for injury. Or the shoulder? But it was a bizarrely misleading headline. Perhaps the knee? A bizarre and amazing study published in the New England Journal of Medicine in showed that a placebo for knee osteoarthritis is just as good as real surgery.
Except maybe this?
But not a safe one. Numerous MRI studies of the back over the years have shown just terrible correlation between structural problems and back pain. Surely narrowing of the spinal canal is always painful? Perhaps not. Cranking up the counter-intuitiveness another notch, scientists found in that a structural problem that everyone previously assumed to always be painful — even I thought so!
Hip pain is rarely caused by arthritis … even when the hip joint is clearly arthritic. Most people with signs of arthritis on X-ray do not have any pain, and most people who have hip pain do not have arthritis. Poor pain-degeneration correlation in animals, too! We learn early that we need to treat the animal, not the radiograph. Fang in your throat? The styloid bone at the back of the throat looks like the fang of a sabre-toothed squirrel. It can get too long and start to bother the sensitive anatomy around the tip Eagle Syndrome.
Except, surprisingly, most people with elongated styloids are just fine. Clearly, styloid length is not a hazard in itself — something else has to be wrong. If spinal instability were painful, surely stabilizing it would help?
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Sports injuries aetiology investigations have assumed a reductionist view in which a phenomenon has been simplified into units and analysed as the sum of its basic parts and causality has been seen in a linear and unidirectional way. This reductionist approach relies on correlation and regression analyses and, despite the vast effort to predict sports injuries, it has been limited in its ability to successfully identify predictive factors. More running risk factors: Pronation is only the most famous of a whole posse of similar biomechanical quirks that supposedly plague runners, including some already mentioned above.