Back pain: not a couch potato problem? 🤯 Say what now?

Most people believe that sedentariness is a huge risk factor for back pain, but a new study says “nope!”

And I for one am glad to hear it! As I wrap up another long week mostly in my chair. 🧵 1/5 Lemmers et al. studied a few hundred back pain patients for a year, measuring activity levels with questionnaires (not ideal, but SQUASH was validated with accelerometry).

And the results? 2/5

Funny thing about back pain…

Some patients will feel quite a bit better when they move or position themselves in specific ways. e.g. you might notice that leaning back eases your leg pain—less shooting down the leg. In some cases, pain right in the back itself might back off. This well-documented phenomenon is cryptically known as “centralization” — because the pain retreats from the periphery into the CENTRE of the body. It’s an odd term.

This centralization thing happily happens in roughly FORTY PERCENT of people with back pain.

Is your pain a THROBBING pain?

Pain often has a pulsating quality, especially when it’s severe and acute. If you’ve ever thought about why it pulses, you probably assumed that it’s pulsating WITH YOUR PULSE. I mean, duh!

Except maybe not. “Pulsatile pain” is a clinical term for throbbing pain assumed to be in sync with the arterial pulse.

The throbbing of infections—like a hangnail that’s gotten out of hand—was a good example of a pulsatile pain. Sure feels like blood pushing through ultra-sensitized tissue!

Pick a joint! ANY joint.

Spinal manipulative therapy (SMT) is the wiggling of spinal joints—the staple of nearly all chiropractic/osteopathic therapy (and much physio too). But a 2021 study shows that it doesn’t much matter which joints are manipulated.

Not a great look. 🧵 More specifically, the study showed that there’s no benefit to SMT based on skilled joint selection, which is a nifty angle.

ncbi.nlm.nih.gov/pmc/articles/P…

Conventional wisdom is often a Russian doll of errors within errors within errors. Almost anything that lots of people believe is probably wrong.

E.g. “lactic acid causes soreness.” My blog post today. 🧵 1/4 This statement applies to a lot of things, and I was already rather cynical about “conventional wisdom.” Obviously. Practically have a career based on that. But…

The @YoureWrongAbout podcast has been teaching me to be even MORE cynical. 2/4

If you’re still thinking about lactic acid painfully accumulating in muscles during exercise…time to adjust that mental image! It’s not an acid…doesn’t burn or build-up…does not cause soreness/fatigue. Myths within myths!

Short new post, 1-min read:

painscience.com/microblog/lact… This myth surely isn’t news to many folks here, but I am confident it is still is news (or a valuable reminder) to many. Please share/confess your awareness of this myth:

Many massage therapists have cited this paper because it confirms their bias that massage helps post-exercise muscle soreness. Unfortunately, it’s a classic “garbage in, garbage out” meta-analysis that shows nothing, despite the “positive” conclusion. frontiersin.org/articles/10.33… Just read fine print: there’s a strong and classic pattern of publication bias in the data, with better quality studies finding nothing of interest, and the shittier ones consistently skewing towards the positive.