A diagnosis should focus on finding the aetiology. i.e. knowing why there is an issue (not just naming the problem. Anything idiopathic isn’t a diagnosis, it’s a label IMO).
{IRL I’d want a:
Full history including details of all other ache and pains you experience—location, duration, severity, type, frequency, initiating actions etc. The good reason for you suspecting increased muscle tone? Do you physically feel tense? Spasms? Restricted movements? Other health issues, history of injuries etc.
Thorough clinical exam. Of the primary problem areas checking for heat, swellings, areas that are painful/tender in palpation. Bruising, scarring etc. Testing range of motion and response to movement in various positions.
}
This “DAMN-IT” mnemonic can used to work through possible aetiologies of any body issue. There is some cross-over between categories (“inflammatory” is a common response to something wrong) and it may not be a totally inclusive list (but I can’t think of anything that doesn’t fit somewhere). It’s very a useful tool:
D = Developmental, Degenerative.
A = Autoimmune, Atrophic, Allergic, Anomalous.
M = Metabolic, Mechanical, Mental.
N = Nutritional, Neoplastic.
I = Inflammatory, Infectious, Ischemic, Immune-mediated, Inherited, Iatrogenic, Idiopathic.
T = Traumatic, Toxic.
- - -- ---
So first steps are history & exam. Depending on what shows up:
Possible imaging—radiographs, MRI, ultrasound
Possible other tests—blood work, joint tap (if indicated).
If a clinician finds nothing remarkable on exam, a kind of “you say there’s pain but I can’t find anything specific” the usual process is prescribe rest, anti-inflammatories. +/- ice, physical therapy (some exercises to do) and come back in 3-6 weeks if not better. If you do go back, imaging would be the next step (gotta do something if they come back....)
- - -- ---
Think about the anatomy and were your pain is coming from.
Run though the aetiology list—what categories would you consider possible sources of your symptoms? I know which ones I’d pick out without other clinical signs, but I don’t know your situation so it’s over to you!
I am p>99.999 confident that what I propose is right. I’d like that rigorously tested. Break me, crush me. Release me from the frustration of knowing (with every fibre in my body) that I’m right ; )
If you’re that confident in your position=pain theory, why would you need DAMN-IT? Why would your assessment of a patient do anything other than figure out which of your Big 5 muscles are involved in the pain? If the answer is, “Strengthen the glutes and your pain will stop,” then how is any pain ever properly characterized as degenerative?
Alternatively, if your theory is actually “position=pain/Big 5 unless some other pathology is involved,” then doesn’t your theory only say, “I’m 99.999 percent confident that pain properly diagnosed as idiopathic by someone who doesn’t subscribe to my theory is explained by my theory”?
Here’s the thing. You say you came to LW to get your theory disproven. Fine. But you are so confident in it that you expect to be wrong about one in one hundred thousand beliefs that you hold with that level of confidence. Beliefs I hold to that level of confidence include 9 * 7 = 63, because it’s possible I am misremembering my multiplication tables.
Now. Imagine trying to convince me that 9 * 7 = something else, just you and me in an empty room with no calculators.
This is why your entire sequence went by with minimal engagement and mild upvoting. The amount of work involved in “breaking you” is tremendous, especially over the Internet, especially when your model takes eight disorganized posts and has many irrelevant images in it, and you seemingly haven’t absorbed some basic lessons of The Sequences (TM). If I’m going to spend a bunch of time engaging with your theory and finding cruxes, I want to know in advance that you’ll play by the rules of good reasoning.
I’m not unwilling, but can you first provide three substantive answers to the following question:
My theory is based on anatomical facts, logic (feels like I’m stating the obvious) and my subjective experience. It’s not complicated but there are multiple parts (split over several posts). I find myself using a lot of words in an attempt to explain clearly and simply (unsuccessfully it seems) so attempting to use as few words as possible and clarify my theory:
Base-Line Theory of Health and Movement:
Use the right muscles. Balance and align body and mind.
Anatomy of alignment
Linear structures: Linea alba, supraspinous & nuchal ligaments.
The body is balanced and aligned when midline anatomy can be positioned to create the median plane.
5 main muscles of movement, dynamic balance and alignment
The position of the rest of the body is relative to Base-Line. The body’s core pillar of strength.
Pelvic floor—the Base foundation of the body.
Rectus abdominis—central Line. Supporting all movement. Alignment of the linea alba.
Base-Line to legs:
Gluteus maximus. Strength and stability of posterior pelvis.
Rectus femoris. Align hip and knee joints.
Base-Line to upper body:
Trapezius—to guide the head and arms through a full range of natural movement. Alignment of nuchal & supraspinous ligaments.
Conscious Proprioception
Increased awareness of the sensory feedback regarding position, motion and balance. Feel how to move to increase alignment and balance, starting from Base-Line.
Pains & weird sensations
Using the wrong muscles results in myalgia of imbalance.
Restrictions in connective tissues = stiffness, physical tensions = pain and weird sensations. Restrictions result from tissue trauma (inflammation, injury, infection, surgery, stress etc.) and as long-term adaptation to poor posture. Individual trauma imprints.
Misalignment increases with cumulative damage. Pain spreads.
Mental
Chronic pain negatively affects sleep quality, mental well-being, quality of life. Physical tensions = mental tensions.
- - -- --- -----
So, with “what is Base-Line theory?” cleared up...
What evidence would falsify your theory?
1) Anything that offers an alternative explanation for my decades of pain and subsequent recovery over the past 4 years. I’ve researched my pain for decades. I’ve not come across anything that would invalidate Base-Line theory health and movement. No inconsistencies with what is “known” as far as I can see. (please anyone, tell me different.)
2) Any evidence that what I have experienced is some existential mindfek rather than what I think of as reality. Open to suggestions (very much a joke....)
3) No supporting evidence when ‘use the right muscles to balance and align the body’ is tested.
Two parts to examine:
Test validity of “the right muscles”.
Test “body balanced and aligned” is a good thing.
Many methods to test come to mind both those parts.
Looking for the presence/absence of physical misalignment in chronic pain patients. (Chronic pain patients that can align their midline anatomy to create the median plane would disprove me).
Assessing levels of pain in those who’s body is balanced and aligned. (Full range of natural movement with high pain levels would disprove me).
Studying those with no pain and their state of physical alignment. (Finding grossly physically misaligned people with no/little pain would be evidence to disprove me).
Biomechanical studies as the body as it goes through a full range of natural movement looking at the condition and positioning of the 5 main muscles. The trapezii have the most potential movement and are responsible for the alignment of the upper body, so if I had to pick one muscle pair to study I’d start with them.
For the assessment of chronic pain there is a lot to consider. Technology will bring better recording methods of aches and pains. More specific location, duration, intensity, frequency, type of pain. I’ve plenty of feedback to give on how to record pain more accurately.
One easy assessment for clinicians is to examine the condition of the nuchal ligament. Minimally invasively accessed and should be easily palpated. (I’d like clinicians to have examined a “free neck” to appreciate how much movement there should be and how the nuchal ligament aligns when the head is dropped forward).
Clinical trials.
I’m drooling at the thought of access to motion capture and digital analysis. How many dots would I get? I’d start with the 5 midline markers, hip bones, tibial tuberosities, C7, spine of scapulae … Precise placement of markers is crucial.
Computer analysis allows detailed, blind assessment of movement and state of alignment of participants compared to the calculated potential range of movement for each individual. Assessment at 0, 3, 8 and 16 weeks as rough figures.
Or simpler testing, subjects stand with their back to column/wall. How does it feel/measurements. Then take a few deep breaths and think of aligning your midline to the column. Relax and allow the rest of the body to move as feels natural. Note what moves where. body parts, pain… Use a long, straight stick …
Potential early testing participant groups that spring to mind:
Medical students from several schools. Broadly similar age range. Should have no trouble understanding the anatomy. 1⁄2 the schools told to focus on the 5 main muscles and how they move. 1⁄2 no instructions. Attendance of movement classes for all participants?
A group who do regular exercise classes together to minimise variables to what exercises are used. Take half a class, provide resources (intro. session, videos, pictures) to the relevant anatomy. Encourage focusing on using the main muscles as they move and feeling for the alignment of their midline anatomy. Ask them not to tell the other half of the group acting as the control.
Chronic pain suffers. 1⁄3 told about the 5 main muscles, 1⁄3 told to increase movement, 1⁄3 nothing.
I’ve read Painscience over the years. It’s one of the few places that attempts to cut through the BS of “pain medicine” and I agree with Paul on many things.
However, I am looking at “posture” from a new perspective. (Kind of wish I had another word for body-position—pose? A lot of bad thinking is currently applied to “posture”.)
Posture = the pose you are in = the positioning of all the bits of your body, at any time.
Good posture = good positioning. Enabled by an unrestricted range of movement, normal tensions within the connective tissue system and the appropriate use of muscles.
Bad posture = bad positioning = misalignment of moving parts = increased biomechanical stress. At some point the body will start to generation warning signals—pain.
The body is an incredible machine with a massive capacity to tolerate misusage, adapting its positioning to avoid pain and spread the burden of misplaced forces. Every adaption however, reduces alignment and increases imbalance, a progression of worsening positioning overtime. The more strain/exertion/trauma the body is expose to the more misalignment develops. For the body to function at/near optimal, it much have all potential position possibilities open to it—a full range of movement—allowing whatever posture/position that is most appropriate to be used for the task at hand.
Paul Ingraham says in the article you linked to:
Poor posture is any habitual, self-imposed positioning that causes physical stress, especially coping poorly with postural challenges.
There is a big difference between “poor posture” and “postural stress,” but the distinction seems to be absent from most discussions of posture and ergonomics.
I say poor posture is when there is postural stress. Also posture can be active or passive (conscious engagement of muscles or subconscious brain to body commands to muscles—habits).
If there isn’t stress, it’s not a bad position to be in so it’s not a poor posture. Examples Paul uses:
The most stereotypical poor posture of them all — a hunched upper back, with the shoulders rolled forward
Is this really an example of “poor posture”? If the shoulders can be “unhunched”, if the subject has a full range of movement, hunched is just another pose. Being in a position that is classically labelled “poor posture” isn’t an issue if stress is minimal, and no pain is generated (RSI in wrists much more likely with “texting hunches”). However if movement of the neck and shoulders are restricted, if “hunched” is a fixed feature, the body is less able to adjust when it needs to, so it becomes a bad posture, generating postural stresses.
“Squatting like a baby” …… hopelessly unrealistic for most people.
I understand Paul’s view on this, a few years ago I would have laughed at the thought of getting into a squatting pose and cried out loud twisting and rotating to get into an approximation of the position. I would have battled a lot of pain to stay there, fidgeting and adjusting looking for the least painful option. But I can squat comfortably now. It wasn’t an aim, or something I intentionally did. It’s just another position to move into and out of as I work with the whole of my body, using my Base-Line as starting reference for relative positioning of the rest of my body—to sense my posture for myself and feel how to move to improve my range of motion.
Read though my take on posture. Question the validity of each statement.
Read though Paul’s take on posture. Question the validity of each statement. (I still agree with a fair bit in the article.) Check the references and consider what, who, how was studied. I’m not impressed with the quality of any studies listed. It’d be more efficient if you link to any ones you find that have some validity rather than me trying to comment on them all.
On a personal note, my patellofemoral pain started (bilaterally) when I was about 7 yrs old. I got a diagnosis of chondromalacia patellae, a label that sounded special but did nothing to reduce the pain in my knees. Walking was always painful, occasionally to the point of almost non-weightbearing. The pains shifted around and around in my knee (and the rest of my body) as my posture altered to avoid pain and keep on going. Now that use the right muscles to position my legs to torso (rectus femoris to align hip and knee joints, gluteus maximus to stabilise the posterior pelvis) my knee pains have finally gone.
Thank you for the comment, there’s a lot of questions in there to deal with.
My theory is not not just “position = pain” as you put it. There’s a bit more to what I am saying, but at its shortest:
Chronic malpositioning causes pain. (This pain is currently either labelled as idiopathic, or may have a label/syndrome but it’s cause is still not understood—i.e. still technically idiopathic.)
To break it down:
(As I see it) there are two options with “pain”. Either:
Signals are generated somewhere in the body and we end up experiencing “pain” . (Pathway which involves various stimuli activating ‘tissue sensors’, electro-chemical transmission of information via peripheral nerves to central nervous system (spinal cord to brain) .
Or
Something occurs in the brain that makes us think “pain”.
Malpositioning = increases stress on body. (Misalignment, imbalance. Basic biomechanics.) (Inappropriate/excess) stress is bad. “Pain signals” occur where something bad is occurring.
Why would your assessment of a patient do anything other than figure out which of your Big 5 muscles are involved in the pain? If the answer is, “Strengthen the glutes and your pain will stop,” then how is any pain ever properly characterized as degenerative?
It’s not a matter of “figuring out which of …. 5 muscles are involved in the pain” or of “strengthen” a muscle and stop the pain. I would like to know what I’ve written that led you to these thoughts so I can edit and clarify so others don’t make the same mistake.
As I stated full history and clinical exam are important for a full assessment. Gather all the information/evidence, consider all the possibilities. Lots of things can go wrong in the body.
I was sharing a diagnostic process so the OP can work through the possibilities and rule things in/out. If nothing else shows up indicating other issues, then mechanical/postural/positional/usage issues are the options left—i.e. the “idiopathic pain” my Base-Line theory deals with.
When is “degenerative” a primary aetiology? It is a pathology. Specifically, for joint pain - “degenerative joint changes” may be post-traumatic, post-infection, mechanical ‘wear and tear’, nutritional issues …. Degeneration may or may not be detectable on clinical exam but is something that can be often be seen on imaging. Something for the clinician to show the patient “There, there’s the source or your pain” clinician has made a “diagnosis”, but patient is still in pain and the primary cause hasn’t been found.
There is a lot of cross-over with the DAMNIT list. It is diagnostic tool to run though aetiologies—for any health issue, not just pain. It’s not perfect but it is useful.
How many things induce inflammation?!
.You say you came to LW to get your theory disproven.
What I actually said was “please tear to shreds”. I meant think about what I say, pick apart bit by bit. There’s several threads to pick at. Some real consideration of the anatomical facts I present and how the body is put together. Pointing out any errors.
especially when your model takes eight disorganized posts and has many irrelevant images in it
I’m disappointed that you consider my posts disorganised, but good to know. Thank you. I was hoping they were a progression from facts, definitions and logic to my experiences and updated thoughts. Seems like I failed there.
Feedback is what i want. Some consideration of what I am saying. Pointing out any errors. Some examples of issues with my posts would be great. How much did you read? Where did I lose you? I’ll freely admit that presentation isn’t my strong point and it’s hard to know what level to pitch at. I want to provide accurate anatomy, without it being overwhelmingly wordy. And to provide enough background information for anyone who isn’t familiar with human physiology. When I realised I wouldn’t be publishing a couple of drafts I was working on I did slip some bits into other posts, which might account for a disorganised feel. There is a fair bit of repetition because it does all come down to the anatomy of alignment (midline structures able to align, the body balanced either side) and the 5 main muscles: pelvic floor, rectus abdominis (either side of linea alba), gluteus maximus, rectus femoris. trapezius (either side of nuchal and supraspinous ligaments) that are key to achieving dynamic alignment and balance and having a body that is well-positioned.
I find anatomy easier to understand in pictures rather than words hence many images. And it is all about the anatomy. Which images do you consider irrelevant?
I would really appreciate your thoughts in more detail.
I will be back with a response to what evidence would falsify my theory, it’s more than I can just rattle off.
If you are genuinely willing to give some thought to Base-Line theory then spend some time thinking about the anatomy, finding the muscles on your body and breathing with your Base-Line.
Lie on the floor and take a few deep breaths. Touch your pubic symphysis, navel and xiphoid process in turn. Imagine the line (the linea alba) that joins them extending as you breathe. Close your eyes and focus on the sensory information your body is providing. Give that a go. More than once.
What I actually said was “please tear to shreds”. I meant think about what I say, pick apart bit by bit. There’s several threads to pick at. Some real consideration of the anatomical facts I present and how the body is put together. Pointing out any errors.
Generally, muscles don’t determine posture but fascia do. Using muscles to hold posture is unnecessary waste of energy and adds tension to the body. When bad posture gets fascia to stick together via fibrin the factors that are involved in getting it unstuck in more complex then “you have to have strong muscles” or even acting from those muscles.
That doesn’t mean that muscles aren’t important but “I have a theory that explains everything while completely ignoring the state of the art” just doesn’t give you a complete picture.
Muscles move bones. Muscles do determine posture, along with connective tissues. I did edit my “posture post” after you’d read it. Originally I’d not mentioned the condition of connective tissues affecting posture (a glaring omission!). I find “fascia” too restricting as a term, I’m sticking with connective tissues.
Muscles alter positioning/posture in an active manner.
The condition of connective tissues affects posture in a more passive manner.
factors that are involved in getting it unstuck in more complex
Could you provide details about these factors? This is the stuff I’m looking for.
The anatomy is as near to “fact” as it gets but “restrictions in connective tissues” is my weak spot. I don’t have any specific histological results or evidence past my experience and reasoning based on available knowledge. (What I’ve seen incidentally in various studies over the years does fit with “sticky connective tissues”—inflammation’s a bitch)
I’ve felt the restrictions, heard them, seen them as I’ve moved and released tissues, regaining a little more movement each time. Something is giving, releasing. Connective tissues/ECM is the only tissue it could be (other suggestions welcome). Body wide releases. I can feel my myofascial meridians, where the lines of tension are. I can ‘see’ them when I close my eyes and focus on how my body is moving—proprioceptive feedback from my body giving me a visual representation of the state of my body in lights and colours, flashes and streams.
I’m not saying you have to have strong muscles, I’m saying you have to use the right muscles.
I’m going to wait for your thoughts on what would falsify your theory, because if it’s a real effort, I’ll be more inclined to put in the work you are requesting.
“Irrelevant” was the wrong word re images; sorry to have sent you down a rabbit hole—I should have said, “not obviously necessary to the point being made and/or unaccompanied by some explanation of why I should learn about what’s in the image”. I’d look at an image, read your text on either side of it, and have no idea why you were including it.
If you are genuinely willing to give some thought to Base-Line theory then spend some time thinking about the anatomy, finding the muscles on your body and breathing with your Base-Line.
Lie on the floor and take a few deep breaths. Touch your pubic symphysis, navel and xiphoid process in turn. Imagine the line (the linea alba) that joins them extending as you breathe. Close your eyes and focus on the sensory information your body is providing. Give that a go. More than once.
Why? How many times, for how long? What evidence do you expect this practice to give me in support of your theory? If I don’t feel anything, will you count that as evidence against your theory, or will you explain it as somehow supporting your theory, like Freud would claim that a patient was in denial if they claimed not to have some desire that his theory predicted that they would have?
Why? How many times, for how long? What evidence do you expect this practice to give me in support of your theory? If I don’t feel anything, will you count that as evidence against your theory, or will you explain it as somehow supporting your theory, like Freud would claim that a patient was in denial if they claimed not to have some desire that his theory predicted that they would have?
I can answer each of those questions if you want me to. I am willing to spend the time if you ask but what value are my words to you?
I am offering you a map.
If you want to explore your territory it is up to you.
I will still be back with the big question of anti-theory evidence.
I would be very interested in your prior regarding me passing this test. Even if you don’t want to share, pick a number now. ; )
I’m finding it a valuable exercise, so thank you for the interaction.
I haven’t had a chance to digest this all, but I’d certainly be interested.
A diagnosis should focus on finding the aetiology. i.e. knowing why there is an issue (not just naming the problem. Anything idiopathic isn’t a diagnosis, it’s a label IMO).
{IRL I’d want a:
Full history including details of all other ache and pains you experience—location, duration, severity, type, frequency, initiating actions etc. The good reason for you suspecting increased muscle tone? Do you physically feel tense? Spasms? Restricted movements? Other health issues, history of injuries etc.
Thorough clinical exam. Of the primary problem areas checking for heat, swellings, areas that are painful/tender in palpation. Bruising, scarring etc. Testing range of motion and response to movement in various positions.
}
This “DAMN-IT” mnemonic can used to work through possible aetiologies of any body issue. There is some cross-over between categories (“inflammatory” is a common response to something wrong) and it may not be a totally inclusive list (but I can’t think of anything that doesn’t fit somewhere). It’s very a useful tool:
D = Developmental, Degenerative.
A = Autoimmune, Atrophic, Allergic, Anomalous.
M = Metabolic, Mechanical, Mental.
N = Nutritional, Neoplastic.
I = Inflammatory, Infectious, Ischemic, Immune-mediated, Inherited, Iatrogenic, Idiopathic.
T = Traumatic, Toxic.
- - -- ---
So first steps are history & exam. Depending on what shows up:
Possible imaging—radiographs, MRI, ultrasound
Possible other tests—blood work, joint tap (if indicated).
If a clinician finds nothing remarkable on exam, a kind of “you say there’s pain but I can’t find anything specific” the usual process is prescribe rest, anti-inflammatories. +/- ice, physical therapy (some exercises to do) and come back in 3-6 weeks if not better. If you do go back, imaging would be the next step (gotta do something if they come back....)
- - -- ---
Think about the anatomy and were your pain is coming from.
Run though the aetiology list—what categories would you consider possible sources of your symptoms? I know which ones I’d pick out without other clinical signs, but I don’t know your situation so it’s over to you!
If you’re that confident in your position=pain theory, why would you need DAMN-IT? Why would your assessment of a patient do anything other than figure out which of your Big 5 muscles are involved in the pain? If the answer is, “Strengthen the glutes and your pain will stop,” then how is any pain ever properly characterized as degenerative?
Alternatively, if your theory is actually “position=pain/Big 5 unless some other pathology is involved,” then doesn’t your theory only say, “I’m 99.999 percent confident that pain properly diagnosed as idiopathic by someone who doesn’t subscribe to my theory is explained by my theory”?
At what point are you describing an invisible dragon?
Here’s the thing. You say you came to LW to get your theory disproven. Fine. But you are so confident in it that you expect to be wrong about one in one hundred thousand beliefs that you hold with that level of confidence. Beliefs I hold to that level of confidence include 9 * 7 = 63, because it’s possible I am misremembering my multiplication tables.
Now. Imagine trying to convince me that 9 * 7 = something else, just you and me in an empty room with no calculators.
This is why your entire sequence went by with minimal engagement and mild upvoting. The amount of work involved in “breaking you” is tremendous, especially over the Internet, especially when your model takes eight disorganized posts and has many irrelevant images in it, and you seemingly haven’t absorbed some basic lessons of The Sequences (TM). If I’m going to spend a bunch of time engaging with your theory and finding cruxes, I want to know in advance that you’ll play by the rules of good reasoning.
I’m not unwilling, but can you first provide three substantive answers to the following question:
What evidence would falsify your theory?
My theory is based on anatomical facts, logic (feels like I’m stating the obvious) and my subjective experience. It’s not complicated but there are multiple parts (split over several posts). I find myself using a lot of words in an attempt to explain clearly and simply (unsuccessfully it seems) so attempting to use as few words as possible and clarify my theory:
Base-Line Theory of Health and Movement:
Use the right muscles. Balance and align body and mind.
Anatomy of alignment
Linear structures: Linea alba, supraspinous & nuchal ligaments.
5 midline markers: Pubic symphysis, navel, xiphoid process, jugular notch, external occipital protuberance.
The body is balanced and aligned when midline anatomy can be positioned to create the median plane.
5 main muscles of movement, dynamic balance and alignment
The position of the rest of the body is relative to Base-Line. The body’s core pillar of strength.
Pelvic floor—the Base foundation of the body.
Rectus abdominis—central Line. Supporting all movement. Alignment of the linea alba.
Base-Line to legs:
Gluteus maximus. Strength and stability of posterior pelvis.
Rectus femoris. Align hip and knee joints.
Base-Line to upper body:
Trapezius—to guide the head and arms through a full range of natural movement. Alignment of nuchal & supraspinous ligaments.
Conscious Proprioception
Increased awareness of the sensory feedback regarding position, motion and balance. Feel how to move to increase alignment and balance, starting from Base-Line.
Pains & weird sensations
Using the wrong muscles results in myalgia of imbalance.
Restrictions in connective tissues = stiffness, physical tensions = pain and weird sensations.
Restrictions result from tissue trauma (inflammation, injury, infection, surgery, stress etc.) and as long-term adaptation to poor posture. Individual trauma imprints.
Misalignment increases with cumulative damage. Pain spreads.
Mental
Chronic pain negatively affects sleep quality, mental well-being, quality of life. Physical tensions = mental tensions.
- - -- --- -----
So, with “what is Base-Line theory?” cleared up...
1) Anything that offers an alternative explanation for my decades of pain and subsequent recovery over the past 4 years. I’ve researched my pain for decades. I’ve not come across anything that would invalidate Base-Line theory health and movement. No inconsistencies with what is “known” as far as I can see. (please anyone, tell me different.)
2) Any evidence that what I have experienced is some existential mindfek rather than what I think of as reality. Open to suggestions (very much a joke....)
3) No supporting evidence when ‘use the right muscles to balance and align the body’ is tested.
Two parts to examine:
Test validity of “the right muscles”.
Test “body balanced and aligned” is a good thing.
Many methods to test come to mind both those parts.
Looking for the presence/absence of physical misalignment in chronic pain patients. (Chronic pain patients that can align their midline anatomy to create the median plane would disprove me).
Assessing levels of pain in those who’s body is balanced and aligned. (Full range of natural movement with high pain levels would disprove me).
Studying those with no pain and their state of physical alignment. (Finding grossly physically misaligned people with no/little pain would be evidence to disprove me).
Biomechanical studies as the body as it goes through a full range of natural movement looking at the condition and positioning of the 5 main muscles. The trapezii have the most potential movement and are responsible for the alignment of the upper body, so if I had to pick one muscle pair to study I’d start with them.
For the assessment of chronic pain there is a lot to consider. Technology will bring better recording methods of aches and pains. More specific location, duration, intensity, frequency, type of pain. I’ve plenty of feedback to give on how to record pain more accurately.
One easy assessment for clinicians is to examine the condition of the nuchal ligament. Minimally invasively accessed and should be easily palpated. (I’d like clinicians to have examined a “free neck” to appreciate how much movement there should be and how the nuchal ligament aligns when the head is dropped forward).
Clinical trials.
I’m drooling at the thought of access to motion capture and digital analysis. How many dots would I get? I’d start with the 5 midline markers, hip bones, tibial tuberosities, C7, spine of scapulae … Precise placement of markers is crucial.
Computer analysis allows detailed, blind assessment of movement and state of alignment of participants compared to the calculated potential range of movement for each individual. Assessment at 0, 3, 8 and 16 weeks as rough figures.
Or simpler testing, subjects stand with their back to column/wall. How does it feel/measurements. Then take a few deep breaths and think of aligning your midline to the column. Relax and allow the rest of the body to move as feels natural. Note what moves where. body parts, pain… Use a long, straight stick …
Potential early testing participant groups that spring to mind:
Medical students from several schools. Broadly similar age range. Should have no trouble understanding the anatomy. 1⁄2 the schools told to focus on the 5 main muscles and how they move. 1⁄2 no instructions. Attendance of movement classes for all participants?
A group who do regular exercise classes together to minimise variables to what exercises are used. Take half a class, provide resources (intro. session, videos, pictures) to the relevant anatomy. Encourage focusing on using the main muscles as they move and feeling for the alignment of their midline anatomy. Ask them not to tell the other half of the group acting as the control.
Chronic pain suffers. 1⁄3 told about the 5 main muscles, 1⁄3 told to increase movement, 1⁄3 nothing.
That’ll have to do for now.
Paul Ingraham has written pretty extensively on posture and it’s relationship to pain/dysfunction, surveying the literature and concludes that there’s very little evidence to support a posture/pain connection.
I’ve read Painscience over the years. It’s one of the few places that attempts to cut through the BS of “pain medicine” and I agree with Paul on many things.
However, I am looking at “posture” from a new perspective. (Kind of wish I had another word for body-position—pose? A lot of bad thinking is currently applied to “posture”.)
Posture = the pose you are in = the positioning of all the bits of your body, at any time.
Good posture = good positioning. Enabled by an unrestricted range of movement, normal tensions within the connective tissue system and the appropriate use of muscles.
Bad posture = bad positioning = misalignment of moving parts = increased biomechanical stress. At some point the body will start to generation warning signals—pain.
The body is an incredible machine with a massive capacity to tolerate misusage, adapting its positioning to avoid pain and spread the burden of misplaced forces. Every adaption however, reduces alignment and increases imbalance, a progression of worsening positioning overtime. The more strain/exertion/trauma the body is expose to the more misalignment develops. For the body to function at/near optimal, it much have all potential position possibilities open to it—a full range of movement—allowing whatever posture/position that is most appropriate to be used for the task at hand.
Paul Ingraham says in the article you linked to:
I say poor posture is when there is postural stress. Also posture can be active or passive (conscious engagement of muscles or subconscious brain to body commands to muscles—habits).
If there isn’t stress, it’s not a bad position to be in so it’s not a poor posture. Examples Paul uses:
Is this really an example of “poor posture”? If the shoulders can be “unhunched”, if the subject has a full range of movement, hunched is just another pose. Being in a position that is classically labelled “poor posture” isn’t an issue if stress is minimal, and no pain is generated (RSI in wrists much more likely with “texting hunches”). However if movement of the neck and shoulders are restricted, if “hunched” is a fixed feature, the body is less able to adjust when it needs to, so it becomes a bad posture, generating postural stresses.
I understand Paul’s view on this, a few years ago I would have laughed at the thought of getting into a squatting pose and cried out loud twisting and rotating to get into an approximation of the position. I would have battled a lot of pain to stay there, fidgeting and adjusting looking for the least painful option. But I can squat comfortably now. It wasn’t an aim, or something I intentionally did. It’s just another position to move into and out of as I work with the whole of my body, using my Base-Line as starting reference for relative positioning of the rest of my body—to sense my posture for myself and feel how to move to improve my range of motion.
Read though my take on posture. Question the validity of each statement.
Read though Paul’s take on posture. Question the validity of each statement. (I still agree with a fair bit in the article.) Check the references and consider what, who, how was studied. I’m not impressed with the quality of any studies listed. It’d be more efficient if you link to any ones you find that have some validity rather than me trying to comment on them all.
On a personal note, my patellofemoral pain started (bilaterally) when I was about 7 yrs old. I got a diagnosis of chondromalacia patellae, a label that sounded special but did nothing to reduce the pain in my knees. Walking was always painful, occasionally to the point of almost non-weightbearing. The pains shifted around and around in my knee (and the rest of my body) as my posture altered to avoid pain and keep on going. Now that use the right muscles to position my legs to torso (rectus femoris to align hip and knee joints, gluteus maximus to stabilise the posterior pelvis) my knee pains have finally gone.
Thank you for the comment, there’s a lot of questions in there to deal with.
My theory is not not just “position = pain” as you put it. There’s a bit more to what I am saying, but at its shortest:
Chronic malpositioning causes pain. (This pain is currently either labelled as idiopathic, or may have a label/syndrome but it’s cause is still not understood—i.e. still technically idiopathic.)
To break it down:
(As I see it) there are two options with “pain”. Either:
Signals are generated somewhere in the body and we end up experiencing “pain” . (Pathway which involves various stimuli activating ‘tissue sensors’, electro-chemical transmission of information via peripheral nerves to central nervous system (spinal cord to brain) .
Or
Something occurs in the brain that makes us think “pain”.
Malpositioning = increases stress on body. (Misalignment, imbalance. Basic biomechanics.) (Inappropriate/excess) stress is bad. “Pain signals” occur where something bad is occurring.
It’s not a matter of “figuring out which of …. 5 muscles are involved in the pain” or of “strengthen” a muscle and stop the pain. I would like to know what I’ve written that led you to these thoughts so I can edit and clarify so others don’t make the same mistake.
As I stated full history and clinical exam are important for a full assessment. Gather all the information/evidence, consider all the possibilities. Lots of things can go wrong in the body.
I was sharing a diagnostic process so the OP can work through the possibilities and rule things in/out. If nothing else shows up indicating other issues, then mechanical/postural/positional/usage issues are the options left—i.e. the “idiopathic pain” my Base-Line theory deals with.
When is “degenerative” a primary aetiology? It is a pathology. Specifically, for joint pain - “degenerative joint changes” may be post-traumatic, post-infection, mechanical ‘wear and tear’, nutritional issues …. Degeneration may or may not be detectable on clinical exam but is something that can be often be seen on imaging. Something for the clinician to show the patient “There, there’s the source or your pain” clinician has made a “diagnosis”, but patient is still in pain and the primary cause hasn’t been found.
There is a lot of cross-over with the DAMNIT list. It is diagnostic tool to run though aetiologies—for any health issue, not just pain. It’s not perfect but it is useful.
How many things induce inflammation?!
What I actually said was “please tear to shreds”. I meant think about what I say, pick apart bit by bit. There’s several threads to pick at. Some real consideration of the anatomical facts I present and how the body is put together. Pointing out any errors.
I’m disappointed that you consider my posts disorganised, but good to know. Thank you. I was hoping they were a progression from facts, definitions and logic to my experiences and updated thoughts. Seems like I failed there.
Feedback is what i want. Some consideration of what I am saying. Pointing out any errors. Some examples of issues with my posts would be great. How much did you read? Where did I lose you? I’ll freely admit that presentation isn’t my strong point and it’s hard to know what level to pitch at. I want to provide accurate anatomy, without it being overwhelmingly wordy. And to provide enough background information for anyone who isn’t familiar with human physiology. When I realised I wouldn’t be publishing a couple of drafts I was working on I did slip some bits into other posts, which might account for a disorganised feel. There is a fair bit of repetition because it does all come down to the anatomy of alignment (midline structures able to align, the body balanced either side) and the 5 main muscles: pelvic floor, rectus abdominis (either side of linea alba), gluteus maximus, rectus femoris. trapezius (either side of nuchal and supraspinous ligaments) that are key to achieving dynamic alignment and balance and having a body that is well-positioned.
I find anatomy easier to understand in pictures rather than words hence many images. And it is all about the anatomy. Which images do you consider irrelevant?
I would really appreciate your thoughts in more detail.
I will be back with a response to what evidence would falsify my theory, it’s more than I can just rattle off.
If you are genuinely willing to give some thought to Base-Line theory then spend some time thinking about the anatomy, finding the muscles on your body and breathing with your Base-Line.
Lie on the floor and take a few deep breaths. Touch your pubic symphysis, navel and xiphoid process in turn. Imagine the line (the linea alba) that joins them extending as you breathe. Close your eyes and focus on the sensory information your body is providing. Give that a go. More than once.
Generally, muscles don’t determine posture but fascia do. Using muscles to hold posture is unnecessary waste of energy and adds tension to the body. When bad posture gets fascia to stick together via fibrin the factors that are involved in getting it unstuck in more complex then “you have to have strong muscles” or even acting from those muscles.
That doesn’t mean that muscles aren’t important but “I have a theory that explains everything while completely ignoring the state of the art” just doesn’t give you a complete picture.
Muscles move bones. Muscles do determine posture, along with connective tissues. I did edit my “posture post” after you’d read it. Originally I’d not mentioned the condition of connective tissues affecting posture (a glaring omission!). I find “fascia” too restricting as a term, I’m sticking with connective tissues.
Muscles alter positioning/posture in an active manner.
The condition of connective tissues affects posture in a more passive manner.
Could you provide details about these factors? This is the stuff I’m looking for.
The anatomy is as near to “fact” as it gets but “restrictions in connective tissues” is my weak spot. I don’t have any specific histological results or evidence past my experience and reasoning based on available knowledge. (What I’ve seen incidentally in various studies over the years does fit with “sticky connective tissues”—inflammation’s a bitch)
I’ve felt the restrictions, heard them, seen them as I’ve moved and released tissues, regaining a little more movement each time. Something is giving, releasing. Connective tissues/ECM is the only tissue it could be (other suggestions welcome). Body wide releases. I can feel my myofascial meridians, where the lines of tension are. I can ‘see’ them when I close my eyes and focus on how my body is moving—proprioceptive feedback from my body giving me a visual representation of the state of my body in lights and colours, flashes and streams.
I’m not saying you have to have strong muscles, I’m saying you have to use the right muscles.
I’m going to wait for your thoughts on what would falsify your theory, because if it’s a real effort, I’ll be more inclined to put in the work you are requesting.
“Irrelevant” was the wrong word re images; sorry to have sent you down a rabbit hole—I should have said, “not obviously necessary to the point being made and/or unaccompanied by some explanation of why I should learn about what’s in the image”. I’d look at an image, read your text on either side of it, and have no idea why you were including it.
Why? How many times, for how long? What evidence do you expect this practice to give me in support of your theory? If I don’t feel anything, will you count that as evidence against your theory, or will you explain it as somehow supporting your theory, like Freud would claim that a patient was in denial if they claimed not to have some desire that his theory predicted that they would have?
I can answer each of those questions if you want me to. I am willing to spend the time if you ask but what value are my words to you?
I am offering you a map.
If you want to explore your territory it is up to you.
I will still be back with the big question of anti-theory evidence.
I would be very interested in your prior regarding me passing this test. Even if you don’t want to share, pick a number now. ; )
I’m finding it a valuable exercise, so thank you for the interaction.