By Nick Ng

Oslo. Europe. Across the Atlantic Ocean. Ask me what would I be doing in 2018 last summer, and I would not have predicted that I will be traveling in Europe for the first time in my life. Canada? Sure, it’s just a catapult vault away, but crossing the Atlantic Ocean seemed as unlikely as giving up my diet of tortillas and rice. The second annual PainCloud Convention in Oslo, Norway, seemed too good to “not go,” and last September, I made a strong commitment to crawl out of my southern California bubble. 

In some ways, PainCloud is very similar to the San Diego Pain Summit. Presentation, followed by Q&A, break, repeat. But what I was more interested in was how much do most European physiotherapists and other clinicians understand pain, disability, and exercise compared to the U.S. and Canada, and how would they use that knowledge to their practice. Would their way of doing things be similar to what my American and Canadian manual therapy friends are doing? Would language and culture be significant influences in how they apply their knowledge and communicate with their patients? Well, let’ see what they have to say. 

By Nick Ng

Foam rolling has been known to create known to help increase range of motion, even for a short time, but little is known exactly how long does this short-term change lasts. Researchers from Coastal Carolina University in South Carolina, USA, recruited 29 young subjects (21 women, 8 men) with various experiences with exercise and foam rolling, from recreational athletes to sedentary ones with no experience with foam rolling. (1)

The subjects warmed up by pedaling on a stationary bike for five minutes and performed a vertical jump test and a sit-and-reach test as a baseline measurement. Then they were randomly assigned to a foam rolling group, dynamic stretching group, combo group (foam rolling + stretching), and a control group (no foam rolling) where they rested for more than 20 minutes before retesting. Subjects in the foam rolling group rolled their glutes, quadriceps, hamstrings, and calves for 3 sets for 30 seconds with a 30 second break between sets. 

Results?

By Nick Ng

Many studies in the more than 20 years have shown that spinal pathologies, certain types of posture and pelvic tilts, and similar structural “problems” do not always correlate or associate with pain, disability, and daily function. Even among elite Olympic athletes, MRI scans, and other types of scans found similar trends. 

A recent American study, led by Dr. Michael Wasserman, who is a resident at the Boston Medical Center, found that 52 out of the sample of 100 athletes who competed in the 2016 Rio de Janeiro Olympic Games had various types of spinal pathologies. These athletes had their spine scanned during the event. Among this sample, athletes who were in “athletics”—track and field, for example—had the highest number of positive findings in the scan, with 15 out of 31 athletes (48%). Judo was the next highest with 5 out of 8 athletes (63%), followed by diving and weightlifting—both with 4 out of 6 positive findings (67%). 

​But why do these sports have such high number of positive findings? 

By Nick Ng

How well patients with chronic low back pain respond to physiotherapy treatment can depend on what and how the physiotherapist explains pain to them. Researchers from the International Spine and Pain Institute in Story City, Iowa—led by Dr. Adriaan Louw—found that their subjects seem to respond better to a single leg raise test after they were given a neurological explanation of their pain than the classical biomechanical one.

Sixty-two patients were randomly assigned to the Neuro explanation group or Biomechanical group, and they performed one survey that measured their perception of low back pain and leg pain (Numeric Pain Rating Scale) and two physical tests—standing lumbar flexion and single leg raise (SLR). These were taken prior to and immediately after the manual therapy intervention (central posterior–anterior mobilization). During the treatment, the physiotherapists gave each patient a neuro or bio explanation, which are summarized in the following:  

By Nick Ng

Every season of Game of Thrones or The Walking Dead often have a plot twist that totally catches fans off-guard. Well, I think the same can be said about this year’s San Diego Pain Summit. Not only did it took place at The Dana on Mission Bay (much more convenient for the guests who are staying there) instead of the usual venue across the street in the past three years, we also had a special Pain Panel that shared the experience of pain from the patients’ perspectives. 

By Nick Ng

Back in 2015, I had no idea that the San Diego Pain Summit would sprout into an international conference, branching to different manual therapists and other healthcare professionals in different countries. While it is still quite young, it has already attracted the attention of several of the world's leading pain and related research, including Professor Lorimer Moseley, Dr. Robert Sapolsky, Professor Peter O'Sulllivan, and Dr. Melissa Farmer. How the founder Rajam Roose, who is a former massage therapist of more than 11 years in San Diego, California, corralled these brilliant minds together and coordinated the complexity of legalities, logistics, and lodgings without gnawing her fingers to the bone is beyond my understanding. But the Pain Summit is moving on to their fourth year!

Unlike most fitness and massage events I had attended, what is still unique about the San Diego Pain Summit is the overlapping of various disciplines in manual therapy, personal training and fitness, and psychology. Many of the presenters and educators were able to bridge basic science and clinical research with hands-on practice. You won’t find many vendors trying to sell you trinkets, “tools,” and tonics there; instead, you’ll find plenty of practitioners who are curious about pain science and applying such knowledge to their patients and practice—should you choose to be a social butterfly. But how do you bridge that gap between science and practice? 

By Nick Ng

If you have experienced back stiffness, chances are, the experience is more than just “stiff” muscles or joints. Pain researchers from The University of South Australia recently published their study that suggests back stiffness does not necessarily reflect actual stiffness of the back muscles or spine. Rather, the stiffness that you feel is more likely a perception of the nervous system, a way to protect your back from danger whether it is real or perceived.​

By Nick Ng, BA, CMT

Oftentimes we see blogs and websites about pain, rehabilitation, and exercise from various healthcare and fitness professionals. However, we don’t often read or hear stories from the patients’ or clients’ side of their experience and knowledge. Clinicians and trainers sometimes get caught up in facts, data, and and their own beliefs that they forget about the people whom they see almost daily. 

Not only do these people have chronic pain (or have conquered their pain), but they also have a high interest in understanding their nemesis. So in no particular order of favorites, these four blogs deserve a regular read and share to understand what is going among those who are or were in chronic pain. 

By Nick Ng

If you could watch yourself getting a massage and you have back pain, would that be more effective in reducing pain than watching something else or simply close your eyes like most people? Four researchers from four different universities in Germany decided to find out. 

By Alice Sanvito, LMT

Why are these physicists so rude?
​

Hardly any toxins. That is unless you're exposed to high levels of chemicals, such as chloride, arsenic, mercury, and lead, almost everyday in your work or living environment. But if you live in a typical neighborhood in a First World society, like most parts of the U.S., Canada, and Sweden, then your chances of being constantly exposed to deadly levels of “toxins” is likely to be very low. However, there is a common misconception among massage therapists that massage therapy can “get rid of toxins” or drinking more water help “flush toxins out,” but that isn't exactly how our body works. Also, it is not our responsibility or business to decide whether a client or patient needs to get “detoxed” or not. Unless you are a qualified toxicologist, this is outside of our scope of practice.

By Nick Ng

This morning, I saw two posts on Facebook that address a very prevalent myth that many massage therapists still believe. Alice Sanvito, a massage therapist in St. Louis, Missouri, quoted someone who made big claims that “lactic acid and cellular waists (yes, that's what was written) wring from the muscles and become accessible to the lymphatic system for easy detoxing after a massage with proper hydration. Without hydration after deep tissue massage results in toxins and acids staying in the muscles resulting it soreness and even headaches.” 

Another asked, “How do we address the overwhelming ignorance of our field?” and used the lactic acid release debate as an example. In fact, this shouldn't even be a debate, no more than debating whether our planet is spherical or flat. It's somewhat entertaining to read the comments this early in the morning because they're not scripted like “The Walking Dead” or a Trevor Noah stand-up. That's why I don't watch TV or even own one.

I don't know where the idea that lactic acid is a toxin and can be squeegeed out of your muscles like cleaning your car's windshield come from. What I do know is that massage therapists — even myself occasionally — need to review and understand basic human physiology so that we don't tell our clients, patients, colleagues, and other healthcare professionals such outdated and unsupported beliefs.

By Nick Ng

By Nick Ng

 Many therapists believe that having a “normal” spinal curve is associated with less or no back pain. Thus, people with too much or too little lordosis are at a higher risk of getting low back pain. However, much of the research in the past 20-plus years do not support such causative relationship. 

In fact, a recent systematic review and meta-analysis published in The Spine Journal seem to support the idea that the lack of lumbar lordotic curve angle (LLCA) is indicative of low back pain — that is, IF you only glance at the abstract. Researchers from Seoul, South Korea, reviewed 13 studies — which were only observational studies such as cohort, case-control, and cross-sectional — that totaled almost 800 low back pain subjects and 927 healthy controls. When the data are pooled together, they found that those with low back pain have a lower LLCA than those with no low back pain. (1) While this is generally what the researchers concluded, there is more to the story. 

By Nick Ng

By Nick Ng

A recent NPR article touted that spinal manipulation therapy (SMT) “can alleviate back pain” in its title based on a recent systematic review and meta-analysis that was published in JAMA recently. (1,2) The story stated that “patients reported greater ease and comfort engaging in two day-to-day activities — such as finding they could walk more quickly, were having less difficulty turning over in bed or were sleeping more soundly.”

Despite the benefits, a closer look at the review itself reveals that the NPR news report do not accurately reflect what the researchers found and reported, which misinforms both clinicians and patients in pain about what the evidence of spinal manipulation treatment (SMT) actually says. In other words, the study do not look favorably for SMT for acute low back pain. 

As a massage therapist who works primarily with relatively healthy clients in a spa or house-call environment, I never thought massage therapy has a pretty big role in mental health care. I mean, when someone is suffering from PTSD, Kurt-Cobain level of depression, or high enough anxiety that makes them want to rip paper slowly in strips all day long, I would imagine they would seek  help from a qualified psychologist, psychiatrist, or even a chaplain or rabbi.

But a massage therapist? Even the “registered” subspecies? I wouldn't imagine. But how do massage therapists play a role in working with patients or clients with mental health issues? 

By Nick Ng

Three massage therapists walk into a bar and saw that the bartender is grimacing in pain with one hand on his right lower back. Massage therapist A asks, “Hi Fernando, what's bothering you?”

Fernando replies, “My lower back has been hurting for more than a week, and it seems to worse everyday. I take painkillers occasionally during work, but the pain comes back after I close the bar.”

Massage therapist A thought, “Maybe his quadratus lumborum and psosas are tight. Look at his hip. He has an anterior pelvic tilt and is leaning toward his right.”

Massage therapist B, who remembered that Fernando had went through a bad divorce last year, has been working as a bartender at this busy bar for over 12 years, and never complained about back pain in the past six years, thought, “His back may be tight, but after what he has gone through, maybe his back pain all in his head.”

Massage therapist C, however, asked Fernando, “Have you seen a doctor or physiotherapist? How have you been recently? Did you sleep well last night?”

There is a tendency of us to identify the cause of someone's pain with a narrow, biased perspective. While there is no way of knowing exactly what caused the bartender's back pain just by looking at him, considering his lifestyle, or reading his vitals, taking considerations of various factors — hence the accepted term “biopsychosocial” to describe diseases and pain — and how they interact with each other can help us decide the best treatment plan and how we communicate with a particular client or patient.

By Nick Ng

By Nick Ng

Maybe bodybuilders and those who just want to get buff should include stretching as part of their workout routine. Who knew that stretching at a certain intensity could help elicit muscle hypertrophy? A team of researchers from UBC Okanagan in Kelowna, British Columbia found that six weeks of stretch training creates a “strong enough stimuli to increase muscle thickness and fascicle length and decrease pennation angle” in the lateral and medial gastrocnemii without changing the maximum voluntary contraction of during plantar flexion. (1)