“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.
6,850 total views, 5 views today
11/10/2014 @ 11:28 pm
Thank you for writing this. I’d also like to point out that Dr. Melzack’s name is Ronald, not Robert.
11/11/2014 @ 5:12 pm
Merci beaucoup, Carol.
03/19/2016 @ 4:26 pm
What about Dr. Sarno’s theory to seek a psychologist before doctor,s look at back pain?
11/12/2014 @ 6:45 am
Thank You Nick for taking Tom to task for his poetic inaccuracies in this video. It is imperative that our leaders in the massage and bodywork field get the science right. They need to be challenged to bring their game up to current standards if they want to be leaders in the field. I hope this leads Tom to delve deeply into neuroscience and bring his understanding and teaching up to a level where we all deserve it to be.
11/29/2014 @ 3:17 pm
Thank you, Richard.
“I hope this leads Tom to delve deeply into neuroscience and bring his understanding and teaching up to a level where we all deserve it to be.” If you read his response on his website, he clearly states that he is not likely to “bring his understanding and teaching up to a level where we all deserve to be.”
Myers wrote: “I am well aware of the lack of research correlation between postural set and pain, but I am allowed to hold a contrarian view of this until all the evidence is in. I’m a posture ≠ pain denier.”
11/12/2014 @ 3:20 pm
This website loves to knock down every treatment/modality that has shown over time to help people, yet proposes NO, absolutely zero recommendation on types of treatment. If these concepts are inherently flawed, are you suggesting that psychological methods are superior to manual? I’m all for debate and using science to prove our methods, but it seems that the authors are so caught up in having (often times confounding) research win out, that they have no suggestion of how to actually treat a patient. Until then, I’ll just keep doing that which I have first-hand experience with it working, manual therapy.
11/29/2014 @ 3:14 pm
Hi Dr. D. Thanks for commenting.
“This website loves to knock down every treatment/modality that has shown over time to help people…”
Can you indicate where in throughout this website that supports your statement where it “loves to knock down every treatment/modality that has shown over time to help people”?
“…absolutely zero recommendation on types of treatment.” Health or medical suggestions are outside of our scope of practice, and this isn’t Mayo Clinic or a medical website that offers “solutions.”
“If these concepts are inherently flawed, are you suggesting that psychological methods are superior to manual?” No, that is what the premise of this article suggests. And what concepts are you talking about?
“I’m all for debate and using science to prove our methods, but it seems that the authors are so caught up in having (often times confounding) research win out, that they have no suggestion of how to actually treat a patient.” As I mentioned, this is not a medical website, nor would we suggest anything “how to actually treat a patient.”
“Until then, I’ll just keep doing that which I have first-hand experience with it working, manual therapy.” That’s great.
11/12/2014 @ 10:34 pm
This part got me thinking..
“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.”
In my experience, intentionally or not, bodywork, yoga and massage almost always will bring up emotional pain and releases. Whether we therapists intend it or not. Hence why I wholeheartedly encourage our community to truly study beyond the physical realm. If we teach movement that inevitably triggers emotional release and aim to repress those releases, I argue we are making our clients issues worse. Lets create “safe” spaces for those releases and celebrate the fact that ppl are “going there” and doing the work. we can’t do physics without the math my friends.
11/29/2014 @ 3:19 pm
Thank you, Ashley.
The only part that I am not clear is your statement: “Hence why I wholeheartedly encourage our community to truly study beyond the physical realm.” What do you mean by this?
11/13/2014 @ 12:14 am
“It may be much better for fitness and massage professionals read the actual research themselves rather than taking Thomas Myers’ advice.”
Was he giving advice or stating his opinions based on his own experience? Did he quote scientific studies or suggest that he plants ideas in the heads of his clients? It doesn’t appear to me that Tom is attempting to debunk scientific research… in fact, this guy is at the table with all of the lead fascial researchers.
If we were at a think-tank type event or forum, this kind of idea presentation would be more welcome. Tom has had his hands on many, many bodies. The responses to and from them are not always measurable by the scientific rod.
Throwing mud at Tom doesn’t serve our community of healers. Instead, this should be an open discussion on “intuition, the experiential and science meet in a bar…”
11/29/2014 @ 3:24 pm
“Was he giving advice or stating his opinions based on his own experience? Did he quote scientific studies or suggest that he plants ideas in the heads of his clients? It doesn’t appear to me that Tom is attempting to debunk scientific research… in fact, this guy is at the table with all of the lead fascial researchers.” Did you watch the whole video before you asked these questions, Amanda?
“If we were at a think-tank type event or forum, this kind of idea presentation would be more welcome. Tom has had his hands on many, many bodies. The responses to and from them are not always measurable by the scientific rod.” Maybe they are measurable, maybe not.
“Throwing mud at Tom doesn’t serve our community of healers.” Can you indicate where in the article was mud-throwing? There is a difference between straight put-downs or mud-throwing and criticism based on evidence and reason.
11/13/2014 @ 7:31 pm
I have read the research, and Myers work. There is a happy medium, and to be honest, the clinical outcomes of my patients, in both pain management and musculoskeletal function has vastly improved since adopting some of the research and practical application of anatomy train theory. Clinical practice is not an ‘either/or’ scientific model, and although evidence based practice is the gold standard approach by manual medicine practitioners, there is still a lot of the therapeutic application and outcome that science is unable to explain.
Thanks for shedding additional light and critique on the theory, it is vital to remember however that not one person/approach has all the answers, AND there is a vast body of information/knowledge that is currently unable to be measured and explained by science…
11/29/2014 @ 3:26 pm
Thank you, Coat of Many Colours.
“….it is vital to remember however that not one person/approach has all the answers, AND there is a vast body of information/knowledge that is currently unable to be measured and explained by science…” Science is just scratching the surface still. 🙂
11/14/2014 @ 11:00 pm
I thought that Myers’ video was pretty good until he got to the three types of pain part. That is where it really starts to fall apart! Come on… you don’t have to be a neurologist to avoid using poetry to describe well documented and mostly understood biological phenomena. Or at least you should know better and expect criticism when you do.
11/29/2014 @ 3:27 pm
“…you don’t have to be a neurologist to avoid using poetry to describe well documented and mostly understood biological phenomena. Or at least you should know better and expect criticism when you do.” Have you read his response, Matthew? 🙂
http://www.anatomytrains.com/news/2014/11/14/response-painful-controversy/
11/15/2014 @ 7:00 pm
I agree with Tom, & the research that supports the notion that “pain is an opinion” & what a fantastic concept that is. It is unfortunate that you & your supporters do not seem to understand that Tom uses a great deal of metaphors that are extremely useful to the manual therapist. This was the perspective he was speaking from, not from purely an evidenced based one. However I did enjoy your challenge.
Science has had it’s own problems & a terrible record of not getting the same results when trying to replicate studies, so how do you know that the scientific conclusions you reference are completely accurate unless they have been replicated at least once? In any event, for me this article confirmed the difficulty people have in interpreting symbolism & metaphors from those who do not see the world in the same way as they do.
11/29/2014 @ 3:38 pm
Thanks for commenting and asking, Chris.
“…’the research that supports the notion that “pain is an opinion’…” Where is the research that indicate and support the idea that “pain is an opinion?”
“Science has had it’s own problems & a terrible record of not getting the same results when trying to replicate studies, so how do you know that the scientific conclusions you reference are completely accurate unless they have been replicated at least once?”
The conclusions are based on the best available evidence we have — in this case — pain science, and scientific conclusion are rarely “completely accurate” since they are tiny steps to reach a conclusion that explains a phenomenon.
The Cartesian model had dominated the medical model to address and understand pain for about 350 years, however, it is not a complete explanation since the model doesn’t explain phantom limb pain or pain in the absence of tissue damage or pathology. Currently, the neuromatrix theory of pain by Dr. Ronald Melzack and Dr. David Patrick Wall is the best explanation we have so far, and even this theory have some minor flaws. The better theory isn’t always about being “more right;” sometimes, it is more about being “less wrong.”
https://www.youtube.com/watch?v=KRFanGInvlc
Most recent paper on pain itself by Melzack and Joel Katz. Myers pretty much ignored current pain research and data in his talk.
http://onlinelibrary.wiley.com/doi/10.1002/wcs.1201/abstract;jsessionid=D000F89C4D81C01FD24D3EABB04D3742.f01t02?deniedAccessCustomisedMessage=&userIsAuthenticated=false
“In any event, for me this article confirmed the difficulty people have in interpreting symbolism & metaphors from those who do not see the world in the same way as they do.” The problem with using metaphors and symbolism is that not everyone would see them that way. They may take them literally and misinterpret the meaning.
11/15/2014 @ 11:20 pm
Another perspective from another master
11/15/2014 @ 11:21 pm
another persective
11/16/2014 @ 9:41 am
At first thought of the world being round, there was lacking ‘scientific evidence.’ We are thankful that someone was brave enough to throw the idea out there though so that science could get busy! Science is constantly superseding science. Creative thinking provoked by our own experience and coupled with research is where new scientific theories begin. I am thankful for ‘mavericks’ like Tom for forcing people to get off their butts and not just accept everything science tells us as the ending truth. Truths in science are evolutionary. I find the goal of the author of this article disheartening.
11/17/2014 @ 1:01 pm
I think it’s worth considering why Myers might be overstepping his scope, and why so many people not only tolerate, but applaud. Here’s an exploration of the metaphysics beneath claims that seem to cross from evidence to intuition without knowing where either begins or begins or ends: http://matthewremski.com/wordpress/wawadia-update-19-thomas-myers-misdefines-pain-but-why/
11/29/2014 @ 3:49 pm
Thanks for commenting and writing your own review of his video and his response, Matthew. I think you did a better than I could do.
“…and why so many people not only tolerate, but applaud.” I think there is a tendency for some health professionals, like myself, to fall under the appeal to authority and tradition. When we like someone’s work or find something in that teacher that confirms or appeals to our bias, then it may be likely that we would agree with almost everything the teacher says — with or without evidence.
I had experienced that during my 13-plus years as a fitness trainer and during massage school.
01/07/2015 @ 7:24 pm
Hmmm….. this article sounds like a lot of egotistical competition to me. I do not believe for a second that pain can be scientifically proven. Let it Go! For goodness sake everybody… just live, love and get over yourself!
01/08/2015 @ 5:46 pm
” I do not believe for a second that pain can be scientifically proven.” What makes you believe so?
02/20/2015 @ 12:40 pm
Thank you so much for bringing more voices to the table. Our field desperately needs to have all side represented better.
Having watched many public exchanges where Tom’s poetic nature gets the better of his understanding of science, this doesn’t totally get to the root of the problem. Note that in his follow-up response to you he claims to know the difference between nociception and pain and then continues to get them confused throughout his statement both in the IASP definition of pain and his starfish analogy.
The problem, as I see it, is that bodyworkers feel their empirical knowledge is sufficient to purpose explanations without compiling and contrasting them with physical reality or the hard work of leading scientists. All of us, as clinicians, do this to some extent. Tom just lets it happen in print, and on camera, and doubles down whenever it is challenged.
Keep up the good work.
02/26/2015 @ 6:58 pm
Thank you, Jon. I learned a lot from last weekend’s San Diego Pain Summit. Truly, this talk about pain here is not what pain really is.
“The problem, as I see it, is that bodyworkers feel their empirical knowledge is sufficient to purpose explanations without compiling and contrasting them with physical reality or the hard work of leading scientists. All of us, as clinicians, do this to some extent.” Excellent reminder. Thank you, Jon.
11/12/2015 @ 11:43 am
Thank you, Nick,
As a massage, yoga, pilates therapist, my main objective is to do no harm.
I totally agree that before you take information out there, especially a known leader in the field, please do your homework and due diligence.
“A grin and bare it”, philosophy for massage, yoga, pilates and other forms of activity
is so counter intuitive to improving someone’s quality of life.
11/12/2015 @ 2:12 pm
Wonderful article, thank you for writing it.