Tuesday, November 24, 2015

Well, it worked for me. - No, it didn't.

This showed up again on Facebook recently. The idea that because somebody thinks something worked it must have. It's a common misunderstanding and it is caused by the limitations of human brains.

This particular story was a response to someone posting on the HEMA Alliance page about their impending knee surgery. And it's ensuing rehabilitation needs.

The first response was, "see a doctor". This response wins.

Many people encouraged the OP to get physical therapy. And more importantly to find a PT who has experience with vigorous athletes. After all, most PT is sedentary folks, so they just don't have as many opportunities to work with folks like us.

Then somebody else said, try "tui na". I'd seen the term before, but I had to look it up. It's a traditional Chinese medicine practice (TCM) involving manipulation and massage.

There is nothing wrong with manipulation or massage in and of themselves. They have been covered in my PT program so far. However, because it is TCM these treatments are not guided by the physical reality of what's inside a human body. They are instead guided by unsubstantiated beliefs about structures and energy that have never been shown to exist.

Furthermore, the TCM process for determining what manipulation and massage is necessary are not based on the reality of human physiological processes. I know how manipulation works because I've dissected a human cadaver. And because others have done so for five centuries accumulating knowledge of all the details. TCM does not have this information.

But It Worked for Him

I understand why he thinks this. But the mere fact that he got better does not prove that he got better because of the Tui Na.

The poster describes having undertaken both PT and tui na. And I'll assume that he also rested. So his rehabilitation plan looks like this:
  1. Rest
  2. Physical Therapy
  3. Tui Na
We know, from extensive research and experience, that the first two are sufficient. He didn't need to do anything else to get better. The most parsimonious explanation of his improvement is that he undertook the first two items and so he got better. And that the tui na was simply not relevant.

But this is typical. This person undertook both a medical treatment and an alternative treatment and he credits his improvement to the alternative treatment. Instead of acknowledging the way that PT addressed his rehab needs

Of course, when you've paid money for the treatment and taken time out of your life to get it done, you have a subconscious drive to believe that you didn't waste your time and money. The human brain is incredibly good at rationalization. And that's the better explanation for this person's personal experience.

I'm not saying this person didn't experience what they experienced. I want them to understand which narrative explains their experiences best. We all have our own narratives that we use to interpret the world. But our narratives are not reliable.

It is imperative for humans to acknowledge the limitations and illusions of our mind. Daniel Simons extensively documents this in the book, "The Invisible Gorilla." If you know what that title means then you should already understand this phenomenon a bit. But if you don't know what the title means then watch this video, it's only 1:21 minutes.

I'll repeat something I've said before: I'm not claiming to have a better brain then other people. I suffer from the same illusions and cognitive difficulties as everyone else. Instead, the difference is that I work hard to have "neurocognitive humility" as Steven Novella puts it. I don't have a different brain, I engage in specific behaviors intended to address the known limitations.

And I'm sure I fail at it sometimes.

What's the Harm

Of course, the follow-up question is, "what's the harm?" So what if the tui na did not do anything? Well, the list of harms from these kinds of pseudo-scientific or not at all scientific medical treatments include:
  1. Wasted money - this is real harm, especially for those who struggle to pay for healthcare and since these treatments are usually not covered by insurance (with good reason).
  2. Wasted time - which can also be money lost if a person takes time off from their job for the treatment.
  3. False hope - if a person thinks that an alternative treatment will help and it does not then that is harm.
  4. Delayed treatment - if a person delays getting effective treatment because they undertook an ineffective treatment first then that is harm - a longer period of disability. And it increases the likelihood that the problem cannot be fixed or fixed fully.
  5. Additional, unnecessary and ineffective treatment - it is often the case that pseudo-medicine practitioners fancy themselves as general practitioners able to diagnose all sorts of problems besides the one you came in for. Many of which are just made up. Then they sell you supplements (that they profit from), order tests that are unnecessary (that they profit from) and recommend treatment that does nothing (that they profit from).
  6. The treatment may be harmful - unlike with medicine the alternative medicine field is essentially unregulated and so even harmful treatments are able to proliferate.

Generalizing this Post

This is a bit of a rant. So what does it have to do with strength and conditioning training? Don't believe in fad exercise programs. Don't believe in fad recovery methods. Don't believe in "ancient wisdom" until it has been studied.

Don't believe yourself.

Acknowledge that your own experiences may not accurately represent reality. That your conclusions may be based on the common illusions of the human brain.

The basics of both exercise and injury treatment and recovery are well understood and good results are reliable with these basic approaches. This may seem boring. And it is, but it also works.

So do it.

Monday, November 2, 2015

Help, my shoulders are too high!

We see this plenty in martial arts, fencing and, well, normal life. People who keep their shoulders up too high, kind of bunched up or tense, but all the time. Or maybe just while they are training. For training it's most common in new fencers. Recently somebody asked about it on the HEMA Alliance Facebook page and here's my long response.

Let me get technical for a moment. I'm talking about excessive tension in the upper traps that elevates the shoulder joints. If you're actually looking at something else, then this won't help.

I'm going to address the common advice and suggestions as well as my own thoughts.


A lot of people will suggest stretching for something like this. But stretching is seldom the answer, though it can be part of it. Here's why:

  1. Go stand in front of the mirror.
  2. Depress your shoulders, that is shove them towards the ground - see the third picture
  3. If you can get them to normal posture (the second picture) then muscle length isn't the problem.

Hunched posture - the problem we are correcting
Normal posture - the objective
Depressed posture - should be able to get the shoulders this low
Stretching solves problems when the muscle is short. And such is seldom the case for this particular problem.

If stretching feels good then that's good and go ahead and do it.

If stretching helps relieve tension then that's good and go ahead and do it.

So, by all means, include stretching if you like, but also know that it won't solve the problem.


Yoga for what?

If it's stress reduction then go for it. Lots of people are stressed and any kind of meditation activity that they find stress relieving is a good thing. Stress can be the primary contributor to the elevated shoulder problem. You've probably heard, or are, somebody who says, "I carry my stress in my shoulders".

Finding a good way to reduce your stress is quite important in life. But it's outside the scope of my blog.

If the yoga suggestion is based on the idea that certain of the yoga postures will cure the problem then I want to know which ones. All too often there is just a generic suggestion for yoga as if the whole of it is some cure-all, without looking at the specifics of individual yoga postures.

A quick google search on yoga poses for shoulder problems came up with a whopping zero poses useful to this problem. This does not mean that they don't exist. But it illustrates that a simple suggestion of yoga in general is not sufficient.

Strengthen the Upper Back

Well, we might expect me to be all over a strength training solution!

But the upper back strength isn't the solution to this problem. It's probably the cause, or at least an accomplice.

The upper back muscles are primarily the trapezius and rhomboids. You also have the top part of the spinal extensors, but they don't attach to the shoulder blade or joint.

The traps are a big muscle group that primarily elevates and upwardly rotates the scapula, so that's a possible culprit. And by possible I mean almost certainly it. Though with a possible contribution from the levator scapulae.

So strengthening the already overactive or tight muscles won't help!

The rhomboids downwardly rotate and retract the scapula, so we can rule them out. Strengthening the rhomboids might actually help us, but the upper traps are much bigger, and so we can't win that tug of war with just reverse flys.

Strengthen Other Things

Farmer's Carries - I love farmer's carries. I just spent good money buying equipment to do heavier carries. But that's an exercise where gravity pulls the shoulder down, so they won't help keep the shoulders down in other actions.

Indian Clubs - I'm not a big fan of these, because there is nothing they do particularly well, they're really just a conditioning tool. And they don't have a way to work the muscles to pull down the shoulders. Whether or not they help is entirely dependent on how good you keep your posture while using them. And that's true of a lot of options. So it's really independent of a solution.

But it does indicate something useful. Being mindful of posture during all strength training, especially standing exercises, will help.

Bodyweight exercises - Which ones? Most of them are simply not relevant to the problem. The only relevant one, really, is pull-ups. And so if you are capable of pull-ups then they should benefit this particular problem. But pull-ups are really hard for a lot of people, so they are usually not a good general purpose suggestion.


We are moving progressively closer to the best understanding and solution to the problem with this. Better posture is better. Work to increase the amount of time in good posture and your awareness of your posture - in every part of your life. In particular here is getting the shoulders back and down. If you have a desk job this is a challenge. And addressing that challenge is it's own big topic.

There is also your posture when you are on-guard. When you are in guards with the arms and sword above the level of the shoulder it's natural to also hunch up the shoulders. But you don't have to do that. You can get your arms overhead and keep your shoulders down.

Shoulders hunched high guard position
Shoulder neutral high guard position
You may also have your shoulders elevated in a lot of your guards. In which case switching to pflug or Fiore won't help. Sean Hayes talks about it in this video.

One of the cues for getting your scapula into the right position for overhead guards is to think about sticking your shoulder blade into your back pocket.

* Side benefit of this: it's healthier for your rotator cuff!


Are you tense while you are training? If you're new you probably are. I see this problem an awful lot. And it's understandable. When you start you don't understand any of it, it's all new. There's a lot to concentrate on. And many people naturally hunch up their shoulders in this situation.

I tell people to relax. I then I tell them that relaxing will take a while. You have to get better at the actions to be able to think about relaxing while doing them. When it's new you have too many things to think about to be able to also think about relaxing.

I'm really relaxed while doing the things that I've been doing with a sword for years. It's easy for me at that point. I'm sure a video camera would show more tension in the brand new stuff. But I've also got, at this point, 17 years of martial arts training, so I've got a habit of being relaxed while doing this stuff. And that took time i.e. don't expect a quick fix. This is a long-term project.

The take-away is spend more training time on the stuff that is not super challenging. That's doesn't mean spend it all on the easy stuff. But spend most of your time on the actions that you get mostly right, most of the time. This is actually my general advice to all my students, just based on learning theory. The advanced stuff, that may be stressing you out, should be practiced with a coach who can provide feedback.

Good Strength Training

Of course I'm going to conclude that strength training has a role to play in addressing this! But it may be a much smaller role than the above about stress and tension, depending on the person.

There is a reflex in the body to keep the muscles safe by turning down the activation of opposing muscle groups when activating a particular muscle. So an overactive upper trap is turning down the activity of the opposing muscles that pull the shoulders down.

And so we can use that to our advantage. As we train up the muscles that pull the shoulders down we increase their resting tone. This will have the effect of turning down the resting tone in the opposing muscles. And thereby reducing the tendency to hunch up those shoulders

What exercises pull down the shoulders? Lat pulldowns. And pull-ups.

You may think of these as primarily latissimus dorsi exercises, and they are. The lats are a big muscle that pulls the shoulders down - amongst other actions. Your rhomboids will also be helping with these exercises. As well as the lower traps.

And that's pretty much all the muscles that pull your shoulders down. So make sure you are including vertical pulling exercises in your complete strength training program.

Does it Hurt?

If yes, then see a medical professional. I am not a doctor.

If you aren't sure yet then ask following questions:
  1. Has it hurt for more than 2 weeks? If so, see a doctor.
  2. Does it hurt even when you are not training? If so, see a doctor.
  3. Does the pain interfere with any other part of your life? If so, see a doctor.

Specifically, see a physical therapist or orthopedist.


In my experience, the most common cause of this is being new. And that can go on for a very long time. The next most common is generally carrying tension in your shoulders. As such, strengthening, stretching and other exercises have only a small role to play in this type of problem.

However, it's not a self-correcting problem. If you do this when you are new then you will do this always. That's what coaches are for, to spot your errors and remind you to fix them.