I have had my doubts about the popular claim that sitting is the “new smoking” for a while now.  The idea seemed to gain exponential growth and support in the media over the past few years.  It is an effect I will refer to as PSM (Popular-Science Momentum).  We’ve seen this sort of thing throughout history, i.e. unjustified yet perpetuating beliefs (ex. fat consumption or eating eggs are bad for you).  I am glad that PainScience has brought a new study to light, with results contradicting the idea that sitting is as dangerous as smoking.  It doesn’t mean we don’t need to exercise; simply, that we can compensate for sitting by exercising.

I have personally worked with a client with CP (cerebral palsy), who despite being very active and exercise-conscious, MUST sit virtually all day.  In light of research, we now know that those with paraplegia have almost no discrepancy in life expectancy, as compared with “able-bodied” folk.  And, to offer another example which may assist us in concluding that sitting is perhaps not as dangerous as once thought: cultures including Chan Buddhist monks, sit or remain inactive much of the day (and of course, are famous for their good health).  Contextualizing is absolutely necessary.

Here is what PainScience had to say: (full PainScience Sitting not = smoking article)

“This study is a nice FUD-fighter: its results directly contradict the overhyped notion that a lot of sitting is just as dangerous as smoking, an idea that’s been around for a few years now and it reeks of premature, fear-mongering speculation. There was never any good evidence that “sitting is the new smoking,” but this is good evidence that “sitting time was not associated with all-cause mortality risk” in over 5,000 subjects.

This doesn’t remotely get us off the exercise hook. It doesn’t mean that a sedentary lifestyle is safe or healthy, but it does strongly suggest that we aren’t doomed by it (that is, you likely can compensate for a lot of time in a chair by being as active as possible otherwise).

And it’s still possible that sedentariness is unhealthy independently of other exercise, and I’m sure we’re going to see more research about it. Regardless, the scary headlines over the last few years were not defensible, and this new evidence is definitely reassuring.”

Colin Badali, RMT, CSCS

I have to hand it to the fellows at AsapSCIENCE; they really knocked it out of the park with this latest video of theirs.  It explores themes that I am deeply interested in, namely: science, scientific thinking, and preconceived notions/bias.  Here are some of the ideas they presented, and here is the link to the video (it already has ~1.5 million views): AsapSCIENCE War on Science

-Science asks, “how can me make things better?”.  Scientific thinking does not accept the status quo, especially if things are not already perfect.  And as we can all attest to, we do not live in a perfect world.

-Despite all of its achievements, science is often at odds with society.  “We live in a society exquisitely dependent on science and technology, in which hardly anyone knows anythings about science and technology” – Carl Sagan

-When we look to history, ignoring science has led to the crumbling of societies.

-Science is much more than a body of applications and knowledge.  Science is a way of thinking, a way of unraveling the world’s mysteries, to see it’s beauty; looking at all the facts to make informed decisions, instead of relying on preconceived notions and biases. 

-“Science is a way of not fooling ourselves” – Richard Feynman

To introduce this topic, we have Kawasaki, a Toronto Blue Jays player: Kawasaki video – Monkeys + Bananas

 

Everyone experiences muscle cramping at some point, unless you are a monkey, of course.  There are different types of cramping, and the causes can be numerous.  Muscle cramping is defined as an involuntarily and forcibly contracted muscle that will not relax.  Cramps can last seconds or hours.  Skeletal muscle cramps can be categorized into four major types. These include “true” cramps, tetany, contractures, and dystonic cramps. Cramps are categorized according to their different causes and the muscle groups they affect.

“True cramps” are caused by hyperexcitability of nerves responsible for the muscles in question.  These can result from acute injury, or vigorous activity.  “Rest cramps” are those you might get during your sleep, especially within the calf/gastrocnemius muscle.

Dehydration and/or sodium depletion are factors involved. Low magnesium, calcium, potassium are also factors.  Deficiencies in vitamins B1, B5, B6 also potential factors involved.

Another way that cramping might occur is via poor circulation (and, oxygen deprivation as a result of this), which is complicated topic that I will not delve into here.

Not all cramps can be easily categorized however – some cramps are merely a relatively minor portion of more serious conditions such as ALS (amyotrophic lateral sclerosis or Lou Gehrig’s disease), certain radiculopathies, or diabetic neuropathy.

*Although the cause of night cramps (i.e. in the calves) is not easy to determine, I have heard that a good preventative approach might be to stretch regularly, have adequate fluid intake, appropriate calcium and vitamin D intake, perhaps vitamin E supplementation, and perhaps, with physician consultation, magnesium supplementation.

The proposed biophysical effects of therapeutic ultrasound have fallen largely out of favour with people that research the modality.  So why is ultrasound still a multi-billion-dollar industry?  It’s an imperfect world I guess, and it takes a long time for a previously well-intentioned therapy/modality/belief to fall out of favor with those that use it.  Therapeutic ultrasound is quite possibly no better than placebo.  There is a shocking (pun intended) lack of evidence for shockwave therapy as well (a more “intense” version of ultrasound).  I don’t enjoy being negative, but there must be critics in healthcare, if positive change is going to occur.

There might be a reader or two thinking, “well, I’ve had ultrasound and it seemed to work”.  I hear this all the time.  The purpose of the research studies (on Ultrasound, or any modality), is to weed out confirmation bias, belief perseverance, and illusory correlation.  So, for example, if a patient had ultrasound on a painful shoulder three times per week over the course of 1 month, and experienced a significant dissipation in pain, they might assume that it was the ultrasound that lead to these results, when it may have simply been the passage of time, or due to any other mix of confounding variables.

Here is Paul Ingraham, talking about this very subject, a little more eloquently (link to his full article: PainScience Ultrasound article)

“It’s not rocket science. Ultrasound is not a difficult therapy to test,10 and if it works reasonably well, then the results should be pretty clear: simply compare results in patients who received real ultrasound to patients who get a fake instead. To a shocking degree, these simple tests have simply not been done adequately. There should be hundreds of them in the archives. Instead there are just a few dozen.

Between 1995 and 2008, the science that has been done was reviewed in only ten papers that seem worthwhile (11,12,13,14,15,16,17,18,19,20,21). Nine were unambiguously negative about US, and some of them strongly so. Their authors had almost nothing good to say about ultrasound. Conclusions like this one from Windt et al are typical:

As yet, there seems to be little evidence to support the use of ultrasound therapy in the treatment of musculoskeletal disorders. The large majority of 13 randomized placebo-controlled trials with adequate methods did not support the existence of clinically important or statistically significant differences in favour of ultrasound therapy.

Windt et al, “Ultrasound therapy for musculoskeletal disorders: a systematic review,” Pain, 1999″

It is a hotly debated topic is the sport science world.  The answer is, of course, it depends.  Typically, we use ice for acute injuries where inflammation and pain are present.  In such cases, the cold/ice can offer a reduction in inflammation+swelling, as well as pain relief.  And heat for the more chronic and non-inflammatory conditions, which might benefit from an increase in vascularity/blood flow, like pesky “trigger points”, or tendosis (when the tendon has actually broken down, as opposed to tendinitis in which the tendon is merely painful due to inflammation).

What you most likely would not want to do, is apply heat to an acute injury, which will only increase pain+inflammation.  Nor would it be sensible to apply heat to back pain or a “trigger point” if they are not inflammatory in nature.

Seems sensible enough, right?  But what about icing an injury that is inflamed for more than a day or two?  Don’t you want your body’s inflammatory processes to run their natural course? Perhaps.  Or perhaps you want to create what has been referred to as “circulatory gymnastics”, in which 20min-ice-on/20min-ice-off is used, which temporarily suppresses blood flow for 20min, followed by a compensatory increase in blood flow for the next 20min, which can be therapeutic for reasons that are unclear (but could be attributed to a net change in vascularity to an area which is striving to repair itself.  As we know, the only way repair can take place is from nutrients derived from blood).

Bottom line: heat vs. ice depends on the nature of the injury.  Effects should be constantly ax’d/re-ax’d

Once again, PainScience has more on this topic:

https://www.painscience.com/articles/ice-heat-confusion.php

The healthcare world has created a new problem: highly sensitive imaging techniques like MRI’s can pick up degeneration that is normally occurring in healthy individuals.  The very sight of these images can lead a patient down a cascade of negative behaviors associated with an increase in pain, and hence, an iatrogenic phenomenon has occurred.  I first read about this phenomenon in Dr. John Sarno’s books, and although perhaps overstated in some instances, the phenomena that he describes absolutely ring true with certain clients that I’ve seen over the years.

This a tremendous short video which illustrates the powerful affect of nocebo, and the iatrogenic affect that MRI’s and poor communication between healthcare professionals and clients can have on back pain.

http://www.pain-ed.com/blog/2015/09/22/back-pain-separating-fact-from-fiction/

Also, a review of Sarno’s work, by Ingraham of PainScience:

https://www.painscience.com/articles/mind-over-back-pain.php

There are some instances in which I like to make use of the “gate-control theory” (Melzack and Wall, 1965) – especially in cases where clients are looking for immediate pain relief.  A device like the TENS unit has a practical application in moments like this.

The infamous gate theory proposes that pain is caused by activity in small-diameter nerve fibers.  By stimulating the larger-diameter sensory nerve fibers, we can reduce the client’s perception of pain.  Melzack and Wall hypothesized that within the dorsal horn of the spinal cord, a “gating mechanism” exists, which can be manipulated (i.e. opened or closed) to allow or inhibit the transmission of painful information through it, essentially preventing the brain from processing these painful signals.  TENS works, in theory, by selectively exciting A-beta nerve fibres in the skin, which reduces the amount of painful stimulation being transmitted by A-delta and C-fibers (which are smaller).  Optimal frequency for this to occur is ~90-130Hz.  There is also potential for TENS to affect extra-segmental, descending pain pathways by decreasing the release of excitatory neurotransmitters (aspartate + glutamate), and increasing the release of inhibitory neurotransmitters (GABA + serotonin).  Also, potential for modulation of endogenous opiods i.e. endorphins.

Alex Korb Ph.D. writes in his book entitled “The Upward Spiral”: “The results are fairly clear that massage boosts your serotonin by as much as 30 percent. Massage also decreases stress hormones and raises dopamine levels, which helps you create new good habits… Massage reduces pain because the oxytocin system activates painkilling endorphins. Massage also improves sleep and reduces fatigue by increasing serotonin and dopamine and decreasing the stress hormone cortisol.”

In the same vein, this is taken from the abstract of a meta-analysis of Massage Therapy (MT) research: “Single applications of MT reduced state anxiety, blood pressure, and heart rate but not negative mood, immediate assessment of pain, and cortisol level. Multiple applications reduced delayed assessment of pain. Reductions of trait anxiety and depression were MT’s largest effects, with a course of treatment providing benefits similar in magnitude to those of psychotherapy.”

http://www.ncbi.nlm.nih.gov/pubmed/14717648

https://www.painscience.com/microblog/ebm-versus-clinical-experience.html

I’ve read an interview conducted with Dan Lieberman, Professor of Human Evolutionary Biology and put some of his thoughts in bullet format.  The link to the full interview can be found at the bottom of this blogpost.

• most popular sports at Olympics: power sports: 100m dash for ex.
• however, IF you think about humans as being POWER athletes, then really we are “wimps”, compared to other animals
• Usain Bolt can run 10.4 m/s.  Any goat (yes, any goat or sheep) can run twice as fast, with no training!
• typical chimpanzee is ~2 to 5 times more powerful than a human (and they weigh less).
• long distances, however, is where humans shine.  In some cases (high temp.), humans can outrun a horse, and with comparatively little orthopedic/musculoskeletal repercussions (he emphasizes that even non-athletes can run a marathon with a bit of training), i.e. it’s not something extraordinary for humans, unlike Bolt’s sprint time, which is for humans
• “We’re actually remarkable endurance athletes, and that endurance athleticism is deeply woven into our bodies, literally from our heads to our toes. We have adaptations in our feet and our legs and our hips and pelvises and our heads and our brains and our respiratory systems. We even have neurobiological adaptations that give us a runner’s high, all of which help make us extraordinary endurance athletes. We’ve lost sight at just how good we are at endurance athleticism, and that’s led to a perverse idea that humans really aren’t very good athletes.”
• argument is, that we have evolved to be endurance “athletes”.  Hunter-gatherers and subsistence farmers performed huge volumes of work

https://edge.org/conversation/brains-plus-brawn