In my previous post, I alluded to a forum called SomaSimple where pain science is discussed and ideas on treatment models and modalities are challenged. Two folks who are not regularly contributing on the forums, but who are sharing good work on social media are Adam Meakins and Gregory Lehman.
The questions they ask and content they provide have helped shaped my thoughts on both personal training and massage therapy. We are not like a car that needs regular tune-ups and aligning, just like we are not like a computer with software or hardware hang-ups. Greg’s view of the human body is the one that I connect with very strongly: we are a robust ecosystem. I don’t like to think of the human body as fragile, and the ecosystem comparison alludes to the fact that the experience of our interaction with our environment is multifactorial. One thing that can show how multifactorial our experiences are have been shared by Adam and Greg and I’ve found them quite compelling.
When it comes to scans, such as MRIs, they can provide us with a sense of the environment of certain regions of our ecosystem. The regions I wanted to share in this post are the cervical spine, lumbar spine, and knee. Most of this information I found via Adam’s Twitter feed, which is linked above and in the caption of the graphs.
In the cervical spine, a study titled, “Abnormal findings on magnetic resonance images of the cervical spines in 1211 asymptomatic subjects” demonstrated that people without any symptoms (asymptomatic) of cervical spine problems, over 87% were likely to find a disc bulge.
Because of this study, Adam tweeted another two studies: one on the lumbar spine and one on the knee joint showing similar findings:
The number of subjects varied in these last two, and 29% of the subjects in the knee pain study had experienced pain in the month prior, but nonetheless, the findings are important. This goes to show how you are not your scan. Pain is much more about your ecosystem’s interaction with its environment.
As you age, and as you can tell by the studies above, it is very likely you’ll have an “abnormality” if you were to ever have imaging done. “Abnormalities” and pain do not coexist, because if they did, the people in these studies would be experiencing pain of some kind. This is where Greg offers a great resource: Pain Fundamentals: A Pain Science Education Workbook For Patients and Therapists.
When it comes to pain, there’s a few things I’ve come to learn and advice I wanted to offer: 1. Pain is normal and not to be feared, and tissue “abnormalities” do not mean you’ll end up in pain. 2. You should be as active as possible, as long as it doesn’t make the pain worse. 3. You should incorporate novel inputs that help reduce the pain experience (moving in ways that are new to your ecosystem); these inputs should be gradually progressed over time. 4. Manual therapy/massage therapy can help turn the volume down; if the pain returns within a few hours, it probably wasn’t the right approach.
This doesn’t mean that scans aren’t helpful and that you can always avoid big interventions, like surgery, but it does mean that if you utilize physical therapy, massage therapy, exercise, or other interventions to help with your pain, you can help keep your ecosystem running nice and robust. And for fun, here’s a study comparing knee meniscus surgery with a sham surgery. The results? “…the outcomes after arthroscopic partial meniscectomy were no better than those after a sham surgical procedure.” If you can teach the body to reduce a perceived threat, positive things happen.