“Anatomy Trains” Controversy

It seems like almost every field of science has its own maverick who preaches his or her own mantra and worldview on the way things work. Medical science has Dr. Oz and Dr. Mercola. Food science has – no surprise – Food Babe. Evolutionary biology has Ken Hamm. Even pain science has one: Thomas Myers, author of  Anatomy Trains, who had stirred some painful controversy with a recent YouTube video  titled, “Why Does Massage Hurt?”

Anatomy Trains, touted by many personal trainers, massage therapists, and yoga enthusiasts and teachers, discusses the principles behind the body’s structure and fasciae, which are the cobweb-like connective tissues that keep organs and body parts together like Saran wrap throughout the body. In the book, Thomas Myers also talks about “myofascial links” that connect different body parts together like a train that allow or prohibit certain movements.

In the past 13 years since Anatomy Trains was first published, Thomas Myers had garnered a sect of followers – mostly health and fitness professionals – who have taken the information to heart. It is no surprise that some fans of Anatomy Trains may also take Thomas Myers’ message about pain without question.

“Thomas Myers has a personal definition of pain, and it’s not accurate because there can be pain without ‘a motor intention to withdraw’,” explained Jason Erickson, who practice massage therapy in Eagan, Minnesota. “The best current definition of pain used around the world is from the International Association of the Study of Pain (IASP) taxonomy: An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”

While Myers got some points correct in the video, such as the presence and the role of the free nerve endings in nociception, he seems to imply that pain and nociception are the same thing. Nociception is defined by IASP as “the neural process of encoding noxious stimuli.” This can be triggered automatically (e.g. increasing blood pressure or heart rate) or behaviorally (e.g. reflexively withdraw the hand from a hot pan). “Pain sensation is not necessarily implied,” according to IASP.

“Nociception is unfiltered, raw data. It is not a sensation,” Erickson said. “Whether or not nociception is transmitted to the brain is mediated at the spinal cord level, and the significance of what the brain receives is mediated by many different parts of the brain associated with memory, cognition, emotions, learning, sensation, motor control, etc. If something else demands higher brain priority due to psychosocial contexts, the brain may ‘ignore’ that nociception altogether.”

“That contextual interpretation of the raw sensory input is a critical part of whether or not the brain generates the sensation of pain,” Erickson continued. “In this video, Tom refers to yoga practitioners experiencing strong sensations that could be uncomfortable or intense but not painful. He also states that those who are ‘reaching their physiological limits’ may experience pain. Those new to yoga, who have not yet become comfortable with the poses and practices, often lack the contextual learning that would facilitate performing yoga without pain. The practice of yoga (or other strenuous physical disciplines) trains the nervous system to interpret sensory data with a greater discrimination between what represents threat and what does not.”

[youtube http://www.youtube.com/watch?v=XG1A-Ct69ug]

What Erickson refers to is the neuromatrix theory of pain that was developed by Dr. Robert Melzack, a Canadian psychologist, in the late 1980s. This theory evolved from various explanations and theories of pain that traces back to the Cartesian model of pain that was first developed by French philosopher and mathematician René Descartes in the early 17th century.

The Cartesian model states that pain is a stimulus created by tissue damage, such as getting a papercut or a bruise, which elicits pain signals to the brain. At that time, the mind and the body were considered separate entities, not a connected unit. However, the model is not a complete explanation of pain. Other theories were proposed and tested in the late 19th and early 20th centuries, which led to the gate theory of pain, developed by Melzack and neuroscientist Patrick David Wall in the mid-1960s. This is where Thomas Myers goes off the rails from current science because “pain coming into the body” is not accurate.

The gate theory suggests that the spinal cord is the “gate” that send noxious and “positive” signals to the brain. If it is a noxious message, a stimulus that actually damages or threatens to damage tissues, pain is increased in the area where is it threatened or damaged. However, if a stimulus is considered “positive,” then the pain decreases. For example, if a child falls down and bruises his knee and the mother rubs and kisses it, the child may feel better because the noxious messages decreased.

But Melzack and Wall did not find the gate theory to be complete because it did not explain phantom limb pain. How can people still have pain in their arm or leg if it was amputated? This observation gave rise to the neuromatrix theory of pain.

The conflicting signals from vision and the absence of the limb may cause “confusion” in the neuromatrix, which is a collection of all the parts of the brain that interprets pain signals, such as the orbitofrontal cortex, the prefrontal cortex, and the motor cortex. Thus, this newer theory provides a more complete picture of how pain works and why things hurt.

Neuroscientist Vilayanur S. Ramachandran from the University of California San Diego used the neuromatrix theory to speculate upon the origins of phantom limb pain in Brain: A Journal of Neurology in 2009. In his article, Ramachandran noted that “irritation of curled up nerve endings (neuromas), scar tissue in the amputation stump  and  the mismatch between motor commands and the ‘expected’ but missing visual and proprioceptive input” are just a few of the impulse reactions that  may be perceived as pain. Unfortunately, Myers’ personal philosophy and metaphors in presented in the video does not reflect accurately on the current understanding of pain science, which stirred up some controversies among health professionals who saw the video and commented on it.

“I feel that it is misguided and harmful. Myers is a trusted resource for human movement professionals so they will trust what he says and his video is incredibly inaccurate,” said Joletta Belton from Carlsbad, California, who is a graduate student in kinesiology at A.T. Still University. “It will only contribute to the idea that pain is a distinct thing that can be targeted and ‘released’ with manual therapy.”

While pain is not discussed in Anatomy Trains, Myers’ take in the video could mislead his fans. “This gives the wrong impression to therapists, who then perpetuate the belief that pain is the result of an underlying pathology of the tissues,” Belton continued. “They will always look for the injury or imbalance or tight spot or asymmetry or whatever to fix the pain. That’s only part of treatment, not the totality of it. Pain education sets on the path toward overcoming pain, and providing misinformation leads to patients getting lost and possibly never finding their way.”

“I strongly disagree with Tom’s unfounded assertion that there are ‘three types of pain’,” Erickson explained. “Regarding pain stored in the body, Tom basically says this is experienced as fatigue, malaise, and postural changes, but not as pain. Here he is misinterpreting changes in posture and movement as pain instead of as non-painful co-occurring symptoms. As an analogy, it makes a crude kind of sense, but if we’re going to think clearly about our terminology and the underlying processes of pain and altered motor control, then we need to avoid this sort of thing.

“A body under stress with a nervous system that is constantly or chronically interpreting threat(s) from incoming input will normally make adaptive changes including autonomic physiological responses (altered hormone levels, circulatory changes, breathing habits, etc.). These have enormous impacts on how we experience the world. Our postures, habitual movements, gaiting, balance, and coordination may be impacted as well.”

Not everything Myers says in the video stirs up “painful” controversies in the recent video. “I do tend to agree with Tom that the body often attempts to arrange itself so that it feels less threatened,” Erickson added. “These changes in physical arrangement are not always associated with pain, however, and may not be subject to a physical ‘release’. There are psychosocial dimensions that Tom is not addressing here that are at least as important as anything that can be done manually.”

Thomas Myers’ “three types of pain” seem to correlate with the neuromatrix theory’s biopsychosocial model of pain, which refers to the biology, psychology, and environmental and social factors that influences pain. In fact, this model was described in a story told by neuroscientist and pain researcher Lorimer Moseley from the University of South Australia in a TED Talk event in 2011. This may seem to roughly fit Thomas Myers’ point:

[youtube http://www.youtube.com/watch?v=gwd-wLdIHjs]

But when Thomas Myers talks about “pain leaving the body,” things start to go back to being a bit “woo-ish” (medical industry insider slang for ideas of doubtful scientific value.)  “This is the least clear portion of Tom’s talk. My interpretation is that he is primarily referring to mental or emotional experiences that are uncomfortable, and that he seems to think it’s important for a person to have some data,” Erickson said. “I am very concerned about this part, because he says he believes that people can’t be treated for pain without them having some sort of intense physical, mental or emotional re-experiencing of the prior trauma. In my experience, that’s patently NOT TRUE, and I would NEVER, EVER plant that idea in a client’s head. Doing so may actually make it more difficult to help them, and possibly even make their pain worse by creating a false expectation that might never be fulfilled. And then the client may never recover fully.

“Also, massage therapists and bodyworkers should never have the intention of inducing such a mental and emotional response in a client. In doing so, we may actually re-traumatize them. That could make their issues much, much worse. Besides, it is outside of our scope of practice. We are not mental health professionals and should never seek to pretend otherwise.”

It may be much better for fitness and massage professionals read the actual research themselves rather than taking Thomas Myers’ advice. That would be like a dietitian or an obesity researcher reading and listening to Food Babe or Dr. Oz for reliable and credible information. However, there are some things one may learn from Thomas Myers. “Though my personal interactions with Tom have been positive, I think there is more value in studying the actual pain science than there is in listening to him talk about pain. I like some of the hands-on methods he teaches, but I think the reasoning demonstrated in this video is severely flawed by lack of modern medical knowledge about pain, what it is, how it works, and why.”

Perhaps it is a good thing that Thomas Myers stirred up some controversy with his recent video that may cause some clinicians and neuroscientists to experience painful “noxious messages” of their own. When “experts” make such claims, they need quality evidence to back them up, something Anatomy Trains appears to lack. And no, science is not out there to “prove” or “disprove” their claims. The burden of proof is on the claimant, not those who question and remain skeptical. One more thing, Mr. Myers: Massage does not have to “hurt,” and neither should exercise.

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