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This review is called a meta-analysis, which is weird, because “only 1 study met inclusion criteria for intrarater agreement and therefore no meta-analysis was performed.” So it was just a regular old review of 6 studies of how much different experts can agree on the location of myofascial trigger points. Lacking adequate data for statistical pooling, they had to “estimate” an agreement score of 𝛋=0.452 — a rather precise etimate! Of the criteria used to determine the location of trigger points, the most reliable were localized tenderness (.68) and pain recognition (.57). Those are actually decent reliability scores, but the authors conclude that “manual palpation for identification of MTrPs is unreliable.” Based on their estimated scores, this is technically correct but a bit misleading: most attempts to detect pathologies in the body are technically “unreliable,” falling well short of a score of κ=1.0 (perfect agreement), but still much better than κ=0 (coin flipping agreement). 



Full disclosure: I was a Registered Massage Therapist with a busy practice in downtown Vancouver from 2000–2010. Since then, I have made my living writing about musculoskeletal medicine and pain science, with a reputation for a skeptical perspective. This article is biased in the direction of debunking, but I also have a real soft spot for massage therapy, and still make a large percentage of my income from selling a book about trigger point therapy — a popular idea in massage that is maligned by many other skeptics (and with good reason). So I actually have competing, complicated biases. I try to compensate for them by sticking to what the evidence can support, and clearly identifying speculation and experimental therapy for what it is. BACK TO TEXT


Doctors think looking up health information online can be problematic because the computer doesn’t have the same diagnostic skills as a healthcare professional. Physicians determine whether an issue is serious by considering personal factors like a patient’s family history and age. (Wrinkles at age five isn’t normal— sorry, Benjamin Button.) On the other hand, when someone searches for “headaches” online, they may find several sources suggesting they are suffering from something much worse…

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‘To Write Love on Her Arms’ was the name or the article that Jamie Tworkowski wrote for his friend Renee Yohe who was suffering with addiction, depression, self-injury and suicidal thoughts. The article was about the five days that he spent with Renee before she entered a treatment center. What started as a simple attempt to help someone realize that there’s more to life and it’s possible to recover has become a great non-profit organization.
Trigger point masssage is still 100% experimental. It has rarely been directly tested and it has never been done well (and never for back pain specifically, which is probably of the greatest interest).78 If you squint optimistically, you could call the best of the evidence “promising.” You could say that where there’s smoke, there’s fire. But it’s like the smoke from last night’s campfire — more of a smokey smell than a smoke where any fire might be hiding. Dial up even a mild cynical impulse, and the evidence collectively looks more like a damning failure to produce any clearly good news.

Disconnect. Put the phone back down, shut the email folder, walk away. Whenever you feel like making an instantaneous reply in anger to someone who has raised your ire, don't act on it. When we feel angry and stressed, we are more likely to read sinister interpretations into our interactions and if we act on them, our self-righteous anger can be self-fulfilling when the person responds negatively. Sleep on your angry missive and practice the relaxation techniques outlined here.

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