By Nick Ng
Like eating pizza and drinking wine, running should also be done in moderation if we want to reduce your risk in developing hip and knee osteoarthritis. A recent systematic review and meta-analysis published in the Journal of Orthopaedic & Sports Physical Therapy found that recreational runners had a lower incidence of knee and hip osteoarthritis than competitive/elite runners and sedentary and non-running folks. “These results indicated that a more sedentary lifestyle or long exposure to high-volume and/or high-intensity running are both associated with hip and/or knee [osteoarthritis]. However, it was not possible to determine whether these associations are causative or confounded by other risk factors, such as previous injury,” the authors reported. (1)
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
Athletes — especially those who perform activities like marathons and Tour de France — produce a huge amount of lactate compared to most non-athletes. (1) But since cancer cells thrive on lactate as their primary source of fuel, wouldn't that process increase ultramarathoners' and similar endurance athletes' risk of cancer?
A recent research published in Carinogenesis examined the role of lactate on cancer growth (San-Millán and Brooks). In one section of the paper, the authors from the University of Colorado School of Medicine reviewed how exercise and its adaptation could help increase lactate clearance in skeletal muscles, which could reduce the fueling to cancer cells. The authors identified lactate as a primary contributor to angiogenesis, metastasis, protection from the immune system, resisting cell death (apotosis), and sustained glycolysis. (2)
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
For many years, I used to think low back pain is a muscle or spine problem or pinched nerves in the spine. After having read much of the history of pain science and the research by Dr. Ronald Melzack, Dr. Patrick Wall, and Dr. Joel Katz (gate-control theory, neuromatrix theory, phantom pain), low back pain is much more than just “something is wrong with my tissues.” (1,2,3) Although psychosocial factors can affect pain intensity and the perception of pain in general,(4,5) sometimes low back pain can primarily be caused by biological factors, such as irritated or “entrapped” cluneal nerves.
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)
By Jamie Johnston, RMT
It was time for a career change — or rather a career improvement. There was an opportunity to become a first-aid attendant at a sawmill I used to work at, so I took two weeks off dove into the course. It was intense and I was learning to do things I never thought I would actually do to a person. Then, I got the job and the real learning started.
Imagine being responsible for 150 people per shift in a huge industrial place where machines can take a tree and pound it into sawdust. That thought scared the crap out of me. I had no idea if I'd be able to handle the situations I would get thrown into. But one of the senior first aid guys gave me a great piece of advice: “You gotta learn somewhere, so it might as well be here.”
By Nick Ng
It seems like every week there is a new ad on social media that touts its product can “fix” text neck, which is often blamed for neck and back pain. News reports, tweets, and medical claims — mostly from chiropractors — all tell a similar story: “Texting Can Damage Your Spine.” Even some personal trainers jumped on the bandwagon to try to “reverse” text neck with exercise.
However, there isn't any strong or good evidence suggesting that text neck — where your neck looks like this gentlemen on the left — or neck curvature is a reliable indicator for neck or back pain.
By Nick Ng
While my Facebook feed was flooded with shares of the Association of Massage Therapy's research finding of massage therapy for various health issues last week, I stumbled upon an interest Tweet from PainScience's Paul Ingraham:
This led me to probe a little deeper into AMT's research summary. Well, a “little deeper” led to a “lot deeper” than I like.
By Nick Ng, BA, CMT
Despite the advances in our understanding of pain in the last sixty years in research, many manual therapists and fitness professionals are still being taught and adopting outdated ideas about pain. However, there is a small and emerging population of therapists and trainers who are gradually learning (and unlearning) about pain science and how to apply research with their patients or clients.
Even with this gradual movement, we see a lot of myths and misconceptions about pain being posted on Facebook, Twitter, Instagram, and LinkedIn. This leads to some major debunking of these myths online that we often see over and over again like it's Groundhog's Day. If you're sick of seeing the same myths and explanations of why they are inaccurate, well, here's a list from five influential manual therapists on social media who are getting tired of seeing the S.O.S. almost everyday.
By Nick Ng
Updated April 13, 2017: Dr. Gary Fryer, corresponding author of the review, shares his thoughts on this topic.
There seems to be more and more systematic reviews and meta-analyses recently shared on social media that examine the effectiveness or efficacy of a treatment with a specific health problem. Last month, someone shared a Cochrane Review on Muscle Energy Technique (MET) on Facebook, which piqued my curiosity to see what it says.
MET is “a system of manual therapy for the treatment of movement impairments the combines the effectiveness, safety, and specificity of reeducation therapies and therapeutic exercise. The therapist localizes and controls the procedures, while the patient provides the corrective forces and energies for the treatment as instructed by the therapist.” (1) It was developed by an osteopath named Fred Mitchell, Sr., about 50 years ago, which was refined by his son, Fred Mitchell, Jr. “MET uses the patient’s own voluntary muscle contraction in a precisely controlled direction against an operator applied counter-force,” the researchers described in the latest Cochrane Review of MET's effectiveness for nonspecific low back pain. (2)
However, the current philosophical underpinnings of MET is quite uncertain.
“This is a difficult question because I don’t think there is any more a common philosophy that underpins the application of MET,” Dr. Gary Frye explained, who is an associate professor at the College of Health and Biomedicine at Victoria University in Melbourne, Australia.
“Like the profession MET arose from — osteopathy — there are widely differing views on the principles of assessment and treatment, and different authors have emphasized different methods of application and uses of MET. The originator of MET, Fred Mitchell Sr., developed MET within a biomechanical framework using particular spinal and pelvic biomechanical models to guide assessment and treatment. My approach to the underlying principles and application of MET is influenced strongly by what appears supportable from modern research evidence.
“I have written and criticised the mechanistic approach commonly advocated in MET texts because I don’t think these principles are valid, and a purely biomechanical approach is out of touch with modern understanding of pain and disability.
“Rather than applying MET based solely on a biomechanical diagnosis, I think it is reasonable to instead consider the likely physiological actions of the technique, such as pain modulation, changes to motor control, reducing fear and gaining confidence in muscle contraction and movement, and apply it with these aims in mind.”
By Nick Ng and Alice Savito
Sometimes we see a post on social media about a new research finding that adds a better understanding of how our body works. And sometimes these findings may (or may not) apply to what we do with our clients or patients. So how do we know if certain research can be applied to what we do or not? The last thing we want to do is to misinterpret the research and fabricate narratives to fit our opinions.
By Nick Ng
You may remember when you were a kid or teenager, your parents told you to sit or stand up straight or don't slouch or you'll hurt your back. However, this idea that hunching or having too much lordosis alone can cause back pain is not supported by current research. In fact, many studies in the past 25-plus years show very little or no association between posture and back pain. (1)
By Nick Ng, BA, CMT
A recent study published in the Journal of Shoulder and Elbow Surgery challenges the existing idea that shoulder impingement syndrome (SIS) is caused by compression between the coracoacromial arch and the humerus during shoulder elevation above the shoulder height. Oftentimes, patients with SIS tend to have anteriorly tilted shoulders, causing the typical hunching posture. (1) Nine fresh cadavers were used where one scapula and one humerus — along with the rotator cuff muscles, subacromial bursa, and coracoacromial joint capsule — were amputated from the body and were mounted on a contraption that specifically measures a shoulder's range of motion within a given plane of motion.
By Nick Ng
Back in my early personal training years (early to mid-2000s), I have heard that sitting on a stability ball is better than sitting on a typical office chair because it “improves posture” and keeps the core muscles “strong,” which leads to less back pain. However, more than 20 years of research found little to no correlation and causality between having a weak core or “poor posture” and low back pain or that on a stability ball is better for the back.
By Nick Ng
“Manual therapists tend to believe that they are Batman, but they are actually more like Alfred.” ~ Dr. Cory Blickenstaff
When I attended the 2015 San Diego Pain Summit, I had a hard time understanding Dr. Cory Blickenstaff's presentation on “edge work.” Part of the reason may have been the idea that I was surrounded by some of the social media's famous physios and pain researchers, like Dr. Jason Silvernail and Dr. Lorimer Moseley. The “celebrity” presence was overwhelming, like having Michelle Obama and Missy Elliot in my car in that YouTube video. In addition to tweeting and making Facebook updates, I was also glancing at them every few minutes, toying with the thought that I am in the same room with them. I'd probably get the same feeling at Comic-Con.
Another reason is that I was still fairly new to the idea that the outcomes of manual therapy treatments may have more to do with the patients' perception, attitudes, and beliefs and their interaction with the therapist than the treatment itself. (1) I had a hard time wrapping that idea around my brain. I mean, just my interaction and the environment can have an effect on how they feel when they walk out of the clinic.
A year and a half later, however, much of these ideas made better sense to me, which made my work easier to do and to communicate with my clients.
If you break your ankle or recovering from a knee surgery and your leg need to be immobilized for a period of time, you could still minimize the loss of strength and flexibility by working out your opposite leg.
A recent study published in The International Journal of Sports Physical Therapy found that foam rolling improves ankle dorsiflexion for at least 20 minutes on the limb that is rolled on and up to 10 minutes on the opposite limb that has not been foam rolled. (1) Researchers Shane Kelly and Chris Beardsley recruited 26 active university students (16 women, 10 men) for this study and randomly assigned to the foam rolling group or control group. Both groups warmed up by doing double-leg heel raises for ten reps, which is something previous studies on ankle flexibility have done.
By Nick Ng
A recent systematic review published in Manual Therapy did not find a strong association between the curvature of the thoracic spine and shoulder pain — or more specifically subacromial pain syndrome (SAPS) — based on ten studies. This condition is described as a “non-traumatic shoulder pain, localised around the acromion, which worsens during or subsequent to lifting the arm.” However, SAPS is a broad term that encompasses shoulder bursitis, subacromial impingement, and rotator cuff tendinopathy. (1)
Although the review did not find any studies that examine the relationship between thoracic curvature and shoulder function, researchers from the University of Limerick in Ireland found strong evidence that less hunching increases the shoulders' range of motion, including flexion, abduction, and external rotation. In other words, having a more upright posture allows greater freedom of movement, such as reaching higher to the shelf or throwing a baseball with better speed and accuracy. However, Barrett et al added that some studies that involve various extremes of posture and duration in sitting (n=3) “may not reflect how people move in a real life scenario” because they are based on extreme examples of sitting.