By Nick Ng

“You don’t speak Dutch?” said the middle-age gentleman who sat in front of me at a bench inside a Starbucks in De Meern, Netherlands, while I was compiling the feature story for the Summer 2018 issue on my laptop. 

I looked at him, mildly surprised that would say that to me, and smiled. “Sorry, I don’t. I’m just visiting.” I could’ve explained to him that I was visiting the Netherlands for a story in my publication, and I already speak two other languages besides English. I could’ve told him that I used Spanish to communicate with the young barista who spoke little English (his parents were from Spain who immigrated to the Netherlands). Well, I just let it go and continued my work while he mumbled something under his breath. 

Interestingly, most Dutch I had met in my four-night stay in the Netherlands were also fluent in English, like many Norwegians and some Germans I had encountered during my travels in northern Europe last April. The amount of bilingualism and trilingualism (and sometimes even more!) among many Europeans surprised me a bit. And looking back at my last traveling adventure, I never expected that writing and publishing would take me to many places that I did not expect to go so soon.  

With the increase of the awareness and application of the biopsychosocial framework (BPS) of pain and healthcare among manual therapists, I think the “social” piece does not get discussed much on social media, at least within my network. There are a few therapists I know who often include this factors in their discussions, reminding others that we are not just treating pain or structures. 

Many of us—including myself—have experienced discrimination in various flavors. In public, we get stares from people because we’re dating someone of a different race, skin color, height, size, gender, etc. We might get rejected in a job application because of how we look and sound—or even just by reading our name. Some of us might even risk getting harassed more often in the streets. For many living in the United States, this is a regular struggle every single day, every breath. 

How much does this affect their health and risk of developing chronic pain?  

By Nick Ng

A few years ago, I recall seeing many of my friends and acquaintances in physiotherapy talk about how great “Explain Pain Supercharged” was in helping them and their patients understand how pain works. Although I have not yet read the whole book, I had read a few passages when I visited Dr. Sandy Hilton and Dr. Sarah Haag at their Chicago “Mecca” two years ago in November. I loved the way Professor Lorimer Moseley and Dr. David Butler describe and illustrate the concept of pain and its research, written in a way that most fifth graders would understand. 

I thought this book was the Holy Grail to help my clients with acute and chronic pain get even better. Pain education. Much of the research said it works! However, a recent study published in JAMA Neurology seemed to challenge the idea that pain education is better than having no pain education. While much of the research in pain education in the past 20 years have demonstrated benefits to those with low back pain of various intensities, pain education “ has never been tested in a placebo-controlled trial. Any benefits observed in previous trials of patient education for acute low back pain could be explained by nonspecific effects of the clinical encounter or the characteristics of the usual care comparison,” the authors wrote. ​

​That caught my attention. I brewed another pot of coffee and continued. ​

By Nick Ng

For many years, some physiotherapists and other manual therapists have told their patients with pelvic pain to “strengthen their core muscles” to reduce and manage their pain and function. This idea comes from early studies of pelvic pain that the pain is mechanical in nature due to too much strain upon the ligaments in the lumbopelvic region. Co-contraction of the transverse abdominal muscle (TVA) and pelvic floor muscles compresses the region which may protect against strain and lowers the risk of pelvic pain. 

However, pelvic pain—or pain itself—is much more complex than just mechanical issues. 

By Nick Ng

Earlier this year, a German study found that “back pain patients and athletes did not show a different behavior to asymptomatic non-athletes.” (1) In other words, if you were to examine hundreds of people in a day by looking at their standing posture, you would not be able to accurately identify who has low back pain and who does not. This is because of the many variations that humans have, from standing posture to anatomical structures. 

By Nick Ng

Should you get a massage before sprinting or any sport that requires bursts of speed? Probably not. A study that was published recently in Complementary Therapies in Clinical Practice found that massage therapy alone is no better than dynamic warm-ups or a sham ultrasound treatment to improve acceleration in sprinting. (1) 

For the 12-week study, a team of of researchers, led by Dr. Ryan Moran from the University of Alabama, recruited 25 NCAA Division II athletes that included freshmen and upperclassmen with nearly a one-to-one male and female ratio. There were four interventions that were randomly assigned to each athlete: 1) massage only; 2) dynamic warm-up only; 3) massage with warm-up; 4) sham ultrasound. Each group of athletes are rotated in different intervention group in the next session after the first tests were completed. 
​

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.