Massage Myth #2 "It's all connected"

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Massage therapists are trained conspiracy theorists - but don't know it... Man.

“It’s all connected.”

Ever heard this?

“Your right foot over-pronates, causing the knee to drift valgus, dropping the right side of the pelvis and anteriorly tilting it, causing your lumbar spine to deviate laterally and into hyper lordosis, thus dropping the left shoulder, so the right side of your neck is tensioned…blah…blah…”.  Not exaggerating. 

But is it really all connected?  Are these chaotic patterns real?  Can a therapist identify them?  Does it benefit the patient?

Not really.

Problem #1: Biomechanics are too complex

 The direction of muscular forces on a left hip joint.

The direction of muscular forces on a left hip joint.

Let's look at the directions of muscular forces acting on a left hip joint.  One joint.  Now imagine running, and understanding what the 650+ muscles in your body are doing with each step.  It's an astonishing and mind-bogglingly complex system.

It's just too complex to confidently start assuming lots of causal connections.  Unfortunately the industry is flooded with over-confident narratives, which usually precedes a new 'advanced' technique or gimmick to fix said problem.

So everything is connected, but the relationship is usually too difficult to comprehend.

 

 

 The correct answer: "I Don't know, you can't know for sure"

The correct answer: "I Don't know, you can't know for sure"

Problem #2: It's just too easy

It's just too damn easy and tempting to assume an achey bit relates to a wonky bit, that relates to a tight bit.  There is plenty of published research that does show causal links between different parts of the body, e.g. that hip weakness may relate to knee pain, and this is useful to understand.  Collating this kind of research to formulate a sensible rehabilitation plan is good practice.  

But we must be careful, confirmation bias is strong, it makes you see patterns that are not there, makes connections that are coincidence, and makes you feel clever when you say it.  Bit like conspiracy theories.

Overcome it with some critical thinking:

  • Do all people with knee pain have hip pain?
  • Do all people with hip pain have knee pain?
  • Does knee pain cause hip pain, or vice versa?
  • Does something else cause both?
  • Does improvement in one improve the other?
  • Is there a plausible mechanism to describe the relationship?

Now how sure are you?

 

Biomechanics are great for understanding how to lift heavy weights.  A good squat or deadlift is certainly achieved by understanding levers,  forces, moment arms and torque.  But pain is complicated and multifactorial, and what causes and alters pain goes way beyond biomechanics.  We also need psychology, neuroimmunology, evidence-based movement strategies and pain science.  

Yes, technically everything in your body is connected.  If you've had a sore left ankle for a while, an now your right hip hurts, maybe you've been limping and your good side's just a bit tired.  Fine.  But let's know our limits and keep it simple.  It's about offering helpful advice to manage, or get out of pain, not sounding clever.

 

Keepin' it Moose,

Tris