Painscience.com and Hargrove’s “A Guide To Better Movement” are pretty good for a model of predictive processing and the roll of the nervous system in chronic pain and movement. I still don’t feel like I have a good model of bone and joint health in general, however. Eg, I’m currently nursing a flare up of patelo-femoral pain in my left knee. I’ve done a number of things over the past few months to deal with it, with some success, including buying and reading Painscience’s book length patelo-femoral tutorial. Recently I’ve had a bit of pain in my foot, possibly in the tibiocalcaneal or tibionavicular tendons. I find that even though I now know a fair amount about PFS and the way the nervous system processes pain, these models don’t generalize well to sporadic, idiopathic pain in another joint.
Possibly the answer is: “lol that model doesn’t exist”, or “lol wanna get a phd?” but if there are good resources, I’d be an eager consumer.
A sub-question that I’m particularly interested in is: what, if anything, is know about the relationship between base line muscle tone and joint issues? I have good reason to think my baseline muscle tone is higher than average.
A lot of my related knowledge comes from in person teaching and not from reading books, so I unfortunately can’t point you to specific sources for everything.
The best related research does come these days from the people that gather around the Fascia Research Congress. A few Rolfers like Robert Schleip and Thomas Myers decided to give academic science a go and across bodywork discipline and related academia the Fascia Research Congress is the central venue for going beyond the methologies of individual disciplines.
Tense fascia leads to high muscle tone and that can then make individual body parts tense enough to hurt. When the problem travels between different parts of the body that’s often what’s happening
From that point it frequently also happens that you get inflammation in that body part which produces additional issues.
As humans age, bones in various joints grow which results in a loss of flexibility. It might be that this isn’t true for a hunter gatherer who uses his joints a lot more then the average Westerner but bone growth does reduce flexbility of joints as people grow older.
Cartilage like the meniscus for the knee often gets thinner over time which produces joint problems. The old fashioned belief is that such cartilage doesn’t grow back. These days we have research at the leading edge that suggest that sometimes some cartilage grows back but we don’t have good models about it.
Various other illnesses also lead to joint problems. Lymn disease for example can produce joint pain.
I’ll look into the Fascia Research Congress and these two!
Does that suggest that trigger-point release, various forms of massage and something like Paul Ingraham’s mobalization prescription are good starting places?
Any suggestions how to tell if you have inflammation and what to do if you do? Ingraham’s Patella Femoral Syndrome tutorial is basically a book disquisition about low-level systemic inflammation in the knee cap, and his prescription is: lots and lots of gentle rest. He suggests the knee cap may be an unusual joint in that it it’s under a lot of pressure even if just sitting still with a knee bent at 90 degrees, so recovery can be hard, but I’m guessing “lots of rest + standard PRICE treatment” is the typical prescription for other inflamed joints?
Thomas Myers wrote Anatomy Trains two decades ago which is a text book that was important for giving the field form. At that time it was state of the art. The general concept of myofascial meridians is a very useful gearmodel. On the other hand it’s two decades old and I have been told that a lot of the book is outdated and Myers himself is not a person who’s good at updating.
Robert Schleip is these days seen more as an authority.
Inflammation generally means that the knee starts hurting when you use it and it starts hurting more when you use it more. It’s worth noting here that a torn muscle can also hurt if you put pressure on it. Infortunately, I can’t tell you much more here.
Inflammation does mean that the joint needs rest but it’s important to move enough to not get more stiff. Ibuprophen can also reduce inflammation. In December after just being inside for a few weeks I went walking and put too much stress on my new. A week of Ibuprophen was what my aunt who’s a normal doctor recommended.
But that wasn’t “low level inflammation”. When it comes to “low level inflammation” I think it’s hard to know what’s going on. When it comes to fascia or muscles you have osteopaths you have good feedback loops to understand the effects of their actions by feeling with their hands what happens. When it comes to “low level inflammation” that’s a model that you can’t directly feel with your hands and thus while bodyworkers might have a theory about it being a cause, they don’t have feedback processes to validate that theory.
While the theory of “low level inflammation” is plausible it’s from my perspective problematic that the people talking about it don’t have good ways to know whether they are right or wrong.
It’s similar to how Todd R. Hargrove is someone who gathered the knowledge he has primarily through feedback loops involves movement and is therefore more trustworthy when he says “I you do these movements, that happens” then when he speculates about what the involved neurons are doing.
It’s always good to ask yourself in a field like this where a lot of knowledge doesn’t come out of traditional academia how people know things and whether they are exposed to feedback loops that allow them to know what they are talking about.
My personal experience with messages by people trained in physiotherapy is that they often don’t produce latesting effects, but it depends a lot on the skill level of the person and message is a fairly broad term.
A lot of people who do have skill trained in some particular methology that’s not globally available. What’s globally available is osteopaths who are generally well trained.
I don’t have much experience with trigger-point release myself nor talked about it with someone who understands how things work. If you do observe that it’s a way you can reduce your body tension over periods that are more then a few hours then it’s something in favor of it but it seems very indirect to me.
Are you skeptical of the central nervous system sensitization pain mechanism?
My general prior is to be skeptical of most neuro-based explanations for phenomena outside of neuroscience. Hypothesis might be true, but it’s very hard to check whether they are true. I generally prefer knowledge that’s backed by empirics over knowledge that rests on assumptions about understanding of how a black box works internally.
If your problem is personal, i.e you’re dealing with joint issues, unless you’re suffering from a muscle-wasting disease or are over the age of 50, reading about stuff will be low yield.
Long term joint pain is solved by:
strengthening muscles in order to not put a strain on “weak” joints [evidence: solid]
Hormetic effects joint usage [evidence: weak clinical, but look at e.g. people doing yoga, I’d say this is an issue of people not studying the correct demographics]
Zone 2 training, aka cardio, allowing you to more efficiently partition fuel to muscles and thus do more movement without suboptimal muscle usage [evidence: I’d assume moderate but unsure]
Stability training [evidence: not good because everyone disagrees what exactly this involves, but basically all physiotherapists are doing some form of stability training so it’s obviously useful | overall you can pick a specific older technique and you will get solid evidence, but newer stuff might actually be better, but less tested]
Now, can you optimize past that? Sure you can.
But unless you are already doing, say, 2 hours of zone 2 4-5 times a week, 30 minutes of resistance training 2-3 times a week (the kind where you are in excruciating pain by the end, i.e. proper resistance training not aerobics masquerading as resistance training), 20-40 minutes of daily stability training (could be morning yoga, could be stretching recommend by a therapist, could be whatever).
Then reading up on joint pain will be useless.
It may be that you are an athlete, in which case discount the above, if you’re doing 4-6 hours of effort per day on average then a better model of movement is probably the key. But even then it might make more sense to take a scientific approach and just try different things and be quick to quantify (e.g. don’t look for joint pain after trying a new style of movement, look for proxies in your blood).
But again, if you’re not an athlete, by reading up on this stuff you are simply running away from the real solution, which involves the hard work of building a pattern of 1-2 hours of varied exercise every day.
I did a little quick searching for “knee stability training protocol” and.. found a few things that looked pretty obvious. Quads, hams, calves, etc. More or less what I’d expect. I don’t suppose you have any secret sauce beyond that?
Ie, “train to failure”? If so, I was under the impression that training to failure is now considered less effective/useful.
I’m not an athlete, but what would the proxies be?
No, it’s really very much about your individual body and where you have lacks, you need an in-person trainer to be able to see this and over time as you move more you’ll become more aware of your body and be able to say “Ah, it’s
xarea that’s too stiff, or activating too much, or that should be working but isn’t or whatever”No, training to failure is a bad idea in that it’s both unhealthy (muscle injury, joint issues) and unideal for muscle growth. But from the perspective of most people “training to failure” is actually “training to a few reps close to failure” because outside of people that are fairly advanced it’s close to impossible to push yourself to the gun-to-the-head limit. If you want you can try “train until your form fails and you pinky-promise are unable to keep it no matter what”, and realistically that should suffice.
standard markers of inflammation, ESR, CRP, etc. Or you could even look for the curve of cortisol response and clotting factors with a venous catheter, I guess. But again, not at all relevant outside of an academic curiosity unless you are training to be an athlet (which is unhealthy and should be avoided).
Thank you for the info! Do you have any thoughts on how to evaluate a trainer’s ability to discern this sort of thing? I’m happy to work with trainers and pay for expertise, but my general sense is that standards of research in sports medicine aren’t great.
Are you implying I shouldn’t [overly] worry about chronic inflammation? I’m pretty confident there is an inflammatory component here—icing and voltaran do seem to help. It’s been long enough (3 months) that I’ve started to think about trying a curcumin supplement and/or just cooking with tumeric+black pepper a bunch.
Oh, not at all, chronic inflammation could be a thing.
I’m just saying that tracking how your exercise routine affects chronic inflammation is a very min-maxy type of things.
Chronic inflammation could very much be a macro problem that leads to joint pain.
Did you already test basic stuff? Like immune cell counts, homocysteine, uric acid, CRP, fibrinogen, ASLO blah. Basically, a standard blood panel an obsessed GP would give you? If not I’d certainly start with that.
I mean, for all you know this thing could be caused by eating too much meat, or gluten intolerance, or whatever (not saying those reasons are especially likely, just examples of “dietary problem that is easily caught on tests and can be easily resolved)