Do you believe in qi?

Do you believe in qi?

When I practice qi gong or t’ai qi, I do not trouble myself with whether or not the qi is “real.” Qi gong is an art. I practice it in a beautiful way. Like Japanese cuisine, it works best when it looks good. To do a thing in a beautiful way, to move gracefully, is to experience qi. Is beauty a real thing? Yes. But there will never be a Beauty-o-Meter®.”

“In the course of the history of our species, we have often cooked up ideas that elegantly but non-literally described a collection of natural phenomena. I believe the Chinese were superb observers of human health, and came up with all kinds of rather beautiful ways of describing what they could not possibly understand. Qi was an attempt to make sense of it — a label for the collective je ne sais quoi of human health and vitality.”

I agreed whole-heartedly with this article.  I think it is possible to appreciate many “traditional” or “alternative” healing arts metaphorically, rather than believing in them literally.  There is still something beautiful about one human being’s attempt to heal another, whether that is through the placing of acupuncture needles, or in the laying on of hands, as in Reiki.  I think these treatments can still be beneficial, whether or not the things their practitioners say about the flow of energy are actually turn out to be true.

As the article points out, we are made of energy, and science has not yet been able to fully measure how it flows throughout our bodies.  Ingraham writes,

“…maybe, someday, we’ll find out there is something like an energy-type qi going on in our bodies. I doubt it, but I’m not completely closing my mind to the possibility — I’m a qi-as-stuff agnostic.

Meanwhile, I am quite happy with qi-as-poetry. And if that is all it ever turns out to be, how can I be disappointed?”

My thoughts exactly.  I suppose there is a remote possibility that someday, science will confirm that there is a flow of energy throughout our bodies that was previously undetected.  It is possible.  I remain open to the possibility, but until then, it is still possible to value and respect different healing traditions while interpreting them metaphorically.

Such a good article.  Your thoughts?

The Scam of “Muscle Energy Testing”

muscles of back

I’ve seen numerous “alternative medicine” providers perform something they call “muscle testing” or “muscle energy testing” many times as part of their sales pitch.  They tell you to put one arm out in front of you, and then push down on your arm.  Your arm sinks immediately.

Then they ask you a question, or put some kind of substance or herbal remedy in your opposite hand, and repeat the “test.”  Your arm always stays up better the second time.  The explanation the quacks will give you is that your body “knows what is best for it” and that your arm is somehow “in tune with the universe” enough to know that what you’re holding in your opposite hand will help you.

As this video points out, none of this is true.  The reason your arm does a better job of resisting the force the second time around is simply because your body has learned what to expect.  As John Duffy, the physical therapist in the video, points out, this represents “simple motor learning.”  In the video, he uses his “magic pen” as a joke to represent the “treatments” that some unethical “alternative health” providers con people into taking using this test.

This video was originally posted on the Phoenix Rehabilitation and Health Services, Inc. Facebook page.  I am including the link to view it on the blog Forward Thinking PT because that is where I originally viewed it, and it seemed to come out in a higher quality there.  (Although I have to admit that this may have more to do with the fact that my computer is ancient than anything else…).

Thanks to EUSKALANATO on Flickr for making the above photo available.

Understanding pain as your body’s alarm system

pretty fire

In my experience, the key to learning to work with your pain instead of against it is to learn to view pain as your body’s alarm system.

In the developed world, most of us are privileged enough to have very little experience with pain.  As children, we only feel pain when we’re at the doctor’s office getting a shot, or when we fall down and skin our knees.  We come to the conclusion that our bodies are designed for us to come to: that pain means something is wrong. 

The truth is that pain a bit more complicated than that.  What I learned from pain neurophysiology education is that pain is the body’s alarm system.  It not only warns us when something is wrong, but when the body thinks something might go wrong.  To help you better understand this, I’ve collected the following anecdotes:

Pain can stop you from injuring yourself

In his amazing online lectures that I think everyone should watch, Neil Pearson instructs his audience to extend one index finger straight up in the air, and then use the index finger of the other hand to slowly bend the first finger backwards.  It doesn’t take long for this to hurt; however, your finger hasn’t actually been damaged.  The pain is your body’s way of telling you to stop, because if you keep going, it will be damaged.

The body’s protective mechanisms don’t always work perfectly.  Case in point: thirst.

There are many ways that our body can warn us to do something, or not to do something.  Thirst is another example.

Thirst is largely controlled by a part of the brain called the hypothalamus.  This part of the brain has a “thirst center” which measures the ratio of blood cells to water in your blood.  When the percentage of water dips below a certain point, your brain tells you are thirsty.

In his book Painful Yarns, Lorimer Moseley explains how thirst is not as accurate a measure of hydration as we generally believe.  He tells the story of two individuals whose car broke down in the middle of the Australian Outback.  They nearly died of dehydration.  When they were finally rescued, they drank until their stomachs were full of water and then told their rescuers they weren’t thirsty.  In fact, they were still severely dehydrated: most of the water they had consumed was still in their stomachs, not circulating in their bloodstream where it could do them any good.

What had happened is that the act of drinking up all that water had temporarily overridden the thirst signals their brains were sending.  The thirst mechanism is designed to get us to drink, and they had drunk all the water their bodies could handle at that moment.  They were still severely dehydrated, yet they weren’t thirsty.

The essence of what I’m trying to say here is that pain and thirst are mechanisms the body uses to get us to take action in some way.  Neither one is always an accurate indicator of exactly what is happening in the body.  They are a sign that the body wants us to do something.

Your body can block out pain signals when something else is more important.

One last thing to know about the pain alarm system is that your body can override it if your survival is in jeopardy.  If you are caught in a situation where your life is in danger, your nervous system might decide it is more important for you to focus on what’s going on around you than what’s going on inside your body.

Neil Pearson gives a great example of this.  He tells the story of a patient he once treated who had been hit by a drunk driver on the way to work.  He woke up upside down in his burning car, and realized he had lost an arm in the accident.

The man managed to extricate himself from the car, collect his missing arm, and walk back up to the side of the highway all without feeling any pain. 

As Neil explains, it’s not as if the nerves in his arm weren’t sending his brain any signals; they were sending signals like crazy.  But his brain knew there were more important things to focus on: retrieving the arm, getting away from the fire, and getting help as soon as possible.  Once he was safely in the ambulance, his brain knew his immediate survival was no longer in question and pain signals set in with a vengeance.

In Conclusion

Pain is your body’s alarm system.  It is not there to give you accurate readings, at all times, of what is going in your body. Rather, it has been designed by millions of years of evolution to get you to change your course of action if your body thinks you need to do something differently.

In the case of people with fibromyalgia and chronic pain, this alarm system has begun to malfunction.  When the body goes through a painful, traumatic experience, it can change the way the nervous system works.  The pain alarm system can become overactive, and your nerves start sending you pain signals at odd times, or all the time, even when nothing is physically wrong.

This isn’t an intuitive process.  As I discusses earlier, pain signals are designed to make us think something is wrong.  Our biology leads us to believe that the amount of pain we feel is equal to the amount of physical damage we have incurred.  But when you begin to understand, on a conscious level, that pain doesn’t necessarily mean there is anything wrong, you can begin to break the cycle of chronic pain.  (I’ll be talking about how in subsequent posts).

Sources:

Beautiful fire picture courtesy of Loving Earth on Flickr.

History of Fibromyalgia as a Diagnosis

As anyone who’s ever wondered if they have fibromyalgia probably knows, the different specialities within Western medicine are not necessarily on the same page in terms of the way they diagnose and treat pain.  Rheumatology has traditionally been the specialty people look to for help with fibromyalgia, yet there are rheumatologists out there who don’t even consider it to be a real disorder (I know, because I had the misfortune of trying to see one of them as a patient).

When you know a little bit about the history of our scientific understanding of pain, the present situation starts to make a bit more sense.  We are living at a time when the medical field’s understanding of pain and the nervous system is changing rapidly.   The discoveries researchers have made in the lab have not quite yet made it all the way into exam rooms where doctors are treating patients.

A little background knowledge can help you to understand why the health care system has been handling this issue so badly.  This, in turn, can help you to speak with more confidence and authority when dealing with those who question whether or not fibromyalgia is a real condition.

Here we go.

***

As far back as the 1700′s, muscle pains were known as “rheumatism” and “muscular rheumatism.” (Ianici & Yunus).

The term “fibrositis” was coined by Sir William Gowers, a British neurologist, in 1904.  The word “referred to the local tenderness and regions of palpable hardness in the muscle, which he attributed to inflammation of fibrous tissue.” (Argoff, Smith, and Evans).

Over the course of the 20th century, doctors used the term fibrositis to refer to myofascial pain syndrome and fibromyalgia,”…as well as almost any unexplained musculoskeletal pain problem.”  These problems were poorly understood, and doctors often assumed that the cause was psychological in nature (or, in other words, that the patient was crazy). (Argoff, Smith, and Evans).

In the 1950′s, two doctors named Janet Travell and David Simons came up with a theory explaining trigger points, which are sections of muscle fibers which become irritated and harden into what is often referred to as a muscle knot.  Janet Travell used her groundbreaking trigger-point-relieving techniques to help then-Senator John F. Kennedy with his “disabling back pain” in 1955.  He relied on Dr. Travell so much that she was appointed White House physician during his presidency, as well as the presidency of Lyndon B. Johnson. (Argoff, Smith, and Evans).

Travell and Simons wrote several books on trigger points and how to treat them.  These doctors did a great service to chronic pain patients, for they provided theory of muscular pain that stemmed neither from a rheumatological condition, nor from the patient’s emotions.  This helped to give pain patients a bit more credibility in the eyes of doctors.

Unfortunately, the field of medicine as a whole still had a long way to go. Through the 1970′s, most medical textbooks still listed the term fibrositis to describe “a disease with strong psychogenic overtones.  (Rosen 1993, as cited by Argoff, Smith, and Evans).  Many people with chronic pain were dismissed as crazy or overemotional.  When Muhammad Yunus, one of the pioneers in fibromyalgia research, told an advisor in medical school that he wanted to study this condition, the response he was given was “‘You will ruin your academic career by dealing with these crazy people.  They’re women.  They’re complainers.  They’re lazy’” (Underwood).

Rheumatologist and ground-breaking fibromyalgia researcher Frederick Wolfe said in an interview, “When the modern era of fibromyalgia started, there were about four or five of us in the U.S. who wrote about it. We saw people who had certain symptoms and we tried to understand what the symptom complex was and what it meant…. When I first started with fibromyalgia you couldn’t get a grant to study it. You sent the grants in and people said, ‘It doesn’t exist. What are you talking about?'”.

Starting around 1976, researchers began to use the term fibromyalgia instead of fibrositis. It’s hard to know who exactly coined the term: many articles give the credit to rheumatologist Muhammad Yunus, but he himself credits others for using the term before him.  The name change signals a shift in condition: rather than looking for an arthritis-like inflammatory condition, now researchers were beginning to look for other causes for patients’ muscular pain (“-myalgia” is the Latin root for pain).

In 1981, Muhammad Yunus and colleagues published the first controlled clinical study of fibromyalgia.  This publication led directly to the medical community recognizing fibromyalgia as a disease.

In 1983, neurologist Clifford Woolfe proposed his theory of central sensitization in a widely-cited letter to the scientific journal Nature.  At the time, it was a controversial groundbreaking theory and was not widely accepted right away.  But today, most researchers believe this increased sensitivity to pain to be the cause of fibromyalgia.  For a great explanation of Woolfe’s work, check out this article.

In 1990, the American College of Rheumatology published a set of standardized criteria for diagnosing fibromyalgia. This is where the well-known concept of tender points comes from: the criteria list 18 possible points on the body, and 11 of them must be sore and tender to the touch on the patient’s body for a diagnosis of fibromyalgia to be made.

In 2010, the American College of Rheumatology proposed a preliminary set of updated criteria for diagnosing fibromyalgia. One significant change in the criteria is that the updated version does away with relying upon the “tender points” test for diagnosing the disorder.

For this reason, I would urge you to steer clear of any medical practitioner who insists that you need to have a certain minimum number of tender points to have fibromyalgia: to me, it is simply a sign that they are not up to date on their research.

I will be adding more information to this as I find it!

Sources:

Argoff, C., Smith, H., and Evans, R.: Myofascial Pain SyndromeClinical Summary for Medlink Neurology website.

Inanici F, and Yunus MB: History of fibromyalgia: past to present. Current pain and headache reports,  Oct. 2004.

Underwood, A. “The Long Search for Fibromyalgia Support.”  New York Times, Oct. 2009.

Wolfe, F. Interview with American College of Physicians Internist, May 2009,

Woolfe, C. “Central Sensitization: Uncovering the Relation Between Pain and Plasticity.”  Anesthesiology, 2007.

Elsevier Health Sciences. (2007, June 25). Further Legitimization Of Fibromyalgia As A True Medical Condition. ScienceDaily. Retrieved February 21, 2017 from http://www.sciencedaily.com/releases/2007/06/070625095756.htm

Why you should learn a little anatomy

Fellow pain sufferers, as well as anyone who likes to learn about the body, I can’t stress enough how learning about anatomy and physiology has helped me.

First of all, it makes such a big difference when you can begin to understand medical terminology.  Once you start studying anatomy, you’ll see that medical terminology, with all of its Latin routes, is kind of like a second language.  But it’s a fun second language and it’s not as hard as it looks, because many words share the same Latin roots.  It really ends up being the roots that you memorize, and the rest comes naturally after that.  For example, the suffix -itis indicates inflammation, whether this is tonsilitis (inflammation of the tonsils), tendinitis (inflammation of a tendon), or appendicitis (inflammation of the appendix).  So you know any word that ends in -itis refers to some kind of inflammation.

It doesn’t take that much to learn these terms, and once you do you’ll find you can actually hold your medical records in your hands and understand about 50% more than what you previously would have been able to.  I’m not saying you have to be your own doctor, but at least for me, understanding these words greatly contributed to my own sense of confidence.  Also, a little background knowledge can make little boring things like having a cold slightly more interesting.  You can think to yourself, “oh, the white blood cells are doing this…” etc. etc.

Secondly, a basic background in anatomy will help protect you from falling prey to healthcare scams and misinformation.  Anyone who’s suffered from chronic illness knows how desperate we can get at times for answers, and this is where a lot of enterprising people try to swoop in and sell you supplements, health counseling, and God knows what else.  There are so many ridiculous, snake-oil cures for sale on the Internet, I can’t even bring myself to do a Google search right now.

As I wrote in a previous post, a lot of people with chronic pain believe they have a problem with inflammation.  I used to think this too, and I was always reading about all of these New Age cures that could supposedly fix the problem (herbs, special diets, etc.)

When I took an anatomy class, I learned about how the inflammatory response works, and I also learned about the various blood tests doctors can order to check and see if a patient has an inflammation problem.  (Examples are sedimentation rate and complete blood count).  Then I went home and looked at my medical records and realized my doctor had actually ordered those tests multiple times over the years.  My results had been normal every time.  Suddenly I realized why she had never seemed to take my concerns about having a problem with inflammation seriously.  I mean, it certainly would have been nice if she could have taken the time to explain all of this to me, but I guess after you spend all that time in medical school you forget how foreign those concepts are to someone who’s never heard of them.

In addition, I have found a huge amount of value in developing an understanding of the part of my body that hurts.  Pain is basically your body’s alarm system, and it’s there to keep you from doing things that your body thinks is dangerous.  Of course this is a totally unconscious process.  But I have found that when I can learn more about a part of the body that’s hurting me, and get to a point where I feel I have an accurate and precise mental model of that area, my pain level actually starts to decrease.  Nobody likes uncertainty, and the more you can develop a sense of certainty about what’s going on, the better you are likely to feel.

Of course, this is not true in every situation with every injury.  I really hate when people take these mind-over-matter theories too far.  You can’t use one theory to explain everything that can happen to people.  But I’ve been able to reduce the level of pain I feel many times by using this technique.

Lastly, a basic knowledge of anatomy will help you to protect yourself from future injury because you will start to know a little bit more about how the body is supposed to work, and you will be less likely to perform your exercises with bad form.

Now I realize that not everybody is able to just sign up for a high-school or college course.  The good news is that there are some ways to get this information on the cheap.

A few suggestions:

  • Try auditing a class.  It’s cheaper than taking it for credit.
  • ExRx.net also has some interesting anatomy information.  Check out this list of muscles.

I know I talk a big talk, but the truth is that it was a lot easier to learn all of this stuff when I was enrolled in a class.  I had some really great instructors and I was buoyed up by their enthusiasm, as well as that of my classmates.  So if you have the opportunity to take a class, I do recommend it.  Knowing you have a test coming up is a great way to force yourself to cram this information in, and assuming you have a good teacher, you will probably learn more that way.  I always check Ratemyprofessor.com before enrolling in anything.

But if you can’t, then definitely check out the resources I suggested.  I definitely think it’s one of the best things you can do for yourself, one that might end up saving you time and money in the end.  Good luck!

Amazing TED Talk: The Mystery of Pain as a Disease

I can’t believe I haven’t seen this video until now.  It was incredibly validating, and I absolutely loved it.

http://www.ted.com/talks/elliot_krane_the_mystery_of_chronic_pain.html

It is given by Elliot Krane, who is a pediatrician and anesthesiologist at Stanford University.  He discusses a lot of the changes that take place in the nervous system of a person with chronic pain in a way that makes total sense.

Favorite quote:

Chronic pain is “…a positive feedback loop…. It’s almost as if somebody came into your home and rewired yours walls so that the next time you turned on the light switch, the toilet flushed three doors down, or your dishwasher went on, or your computer monitor turned off.  It sounds crazy, but that’s what happens with chronic pain.”

Definitely a must-watch!