Pilates, Virtual Reality and Duck Gait
And other things I read about recently
Is Pilates the best exercise for back pain?
My interpretation of the research on low back pain is that different kinds of therapeutic exercise tend to get similar results on average. This is interesting given that they employ very different methods and aim at different therapeutic targets. It makes me think the active ingredient is simply the general health benefits of exercise to body and mind. A particular individual may find that one type of exercise works well and another doesn’t. But they can probably only know this after some trial and error, because different types of exercise work about the same on average.
My friend Ben Cormack recently brought my attention to this October 2021 paper that reaches a different conclusion, finding that Pilates has a better track record of providing pain relief than many other forms of therapeutic exercise. I'm not totally convinced, because the overall quality of research in this area is not great. However, it did prompt me to consider why Pilates might have an advantage, if in fact it does.
I divide exercise modalities for back pain into about five basic categories: strength, mobility, endurance, motor control, and mind-body. (More on this here.) I encourage my clients with back pain to try at least some kind of exercise in each of these different categories, which I see as different pathways for treating pain. For example, if they have only tried aerobic exercise, I would like them to also try strengthening and see if it helps. For people whose pain seems have to have something to do with psychosocial issues, I am curious whether they have tried any form of mind-body exercise, such as Feldenkrais or yoga.
Pilates is an exercise program that checks almost all of the above boxes. This would also be true for a well-designed strength training program. But perhaps Pilates has an advantage in that it has well-standardized programs and coaching methods that make it more likely for people to progress without getting hurt.
This is all just speculation on my part, but I like thinking about the active ingredients in exercise.
Placebos affect the immune system
Placebos work partly by modulating the activity of the nervous system, including the release of endogenous opioids. And the nervous system works closely with the immune system in modulating pain perception, so it would be interesting to know how to placebos affect immune system activity. Here's a new paper looking at this connection.
The study recruited volunteers to undergo a pain challenge while getting a placebo, and then looked at their blood plasma to measure the presence of inflammatory cytokines. They found that the degree of pain reduction from placebo correlated with the release of endogenous opioids and reduction in IL-18, a pro-inflammatory cytokine.
The details are complex and over my head but it's another reminder that whenever you look closely at pain, you can find the immune system playing a key role.
Conventional wisdom on duck gait is wrong
We need research on whether pigeons run with the toes out.
Teens and back pain
Bad news from this paper:
• The prevalence of chronic back pain in adolescents has increased from 2002 to 2014.
• Adolescent girls report a higher prevalence rate of chronic back pain than boys.
• The prevalence of chronic back pain increases with the age of the adolescent.
• The highest increase was reported by 15-year-old girls (7% increase).
Bummer.
Can we put exercise into a pill?
In this study, researchers collected plasma from rats who did a lot of running, and then injected it into rats who were sedentary. What happened?
‘Runner plasma’, collected from voluntarily running mice and infused into sedentary mice, reduces baseline neuroinflammatory gene expression and experimentally induced brain inflammation.
For more information on neuroinflammation, click here.
The practical implications of this study as I see it: Either we should start exercising more, or collect the precious bodily fluids of runners and sell it for money.
Can we put exercise into virtual worlds?
Our annual New Years Eve party was dominated by adults playing with the prize Christmas present that one of the kids received: an Oculus virtual reality video game. I tried playing some Beat Saber, which was awesome. Check out this video for what its like:
Several of the technogeeks that I follow on Twitter have mentioned that Beat Saber is the only time they ever had fun with exercise. I had fun with it as well, but I'm lucky enough to enjoy exercise in the real world. Creepy to think that this may be the best hope we have for getting video-game addicted kids moving. On the other hand, whatever gets people moving is fine with me.
Virtual reality for pain
Scientists are testing virtual reality systems to treat pain. And the FDA just approved marketing of a new VR system developed by Beth Darnall.
More evidence on the benefits of self-efficacy
Current research on the connection between psychosocial factors and pain seems to show that fear of movement, catastrophizing, depression, anxiety, and low self-efficacy are all predictors of bad outcomes. Of these, self-efficacy may be the most important, and probably plays an important role in disability.
I found two studies in the last month that support this view. Here's a systematic review concluding that:
Fear of movement, self-efficacy, catastrophizing and depression were consistently reported to predict disability outcomes irrespective of the type of conservative intervention.
And this study finds that self-efficacy may be especially important:
The results identified a mediating role for pain self-efficacy between the specific psychosocial factors (fear, catastrophizing, and depression) and reported disability. Pain self-efficacy plays a more significant role in the relationships between these specific psychosocial factors and reported disability with CNLBP than previously considered.
For more of these topics, check out my podcasts with Joletta Belton and Bronnie Lennox Thompson, share their personal and clinical experiences with chronic pain.